Copy of Ski Retreat 2106

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* 1. Please enter the following information. Your registration is not complete until all required fields are entered

Name:

Address :

City:

Province:

Postal Code:

Email Address:

Phone Number:

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* 2. I am a:

Youth

Leader

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* 3. What grade are you currently in?

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* 4. Your cell number (for use in emergencies during the weekend):

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* 5. Medical Information:

Allergies:

Special dietary restrictions:

Medications being taken:

Doctor's name:

Doctor's phone number:

Care card number:

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* 6. Emergency Contact Information

Name:

Phone number:

Cell number:

Relationship to youth:

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* 7. Home Congregation (the youth group you came with):

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* 8. On the mountain I am going to:

Ski/Snowboard (means you get up REAL early)

Tube (sleep in)

Hang out at the Chalet (sleep in)

Other (please specify)