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Information

I am registering as a:
StudentLeader

Name

Email

Phone

Birthday

Age
121314151617181919+

Medical #:

Allergies:

Primary Address

Emergency Contact

Name

Relationship to Student

Phone Number

Legal Stuff

I, the undersigned, parent or guardian of the above child, give the above child permission to attend and participate in “Encuentro Missions - Toronto 2027” and all that it entails from July 9-17, 2027. I agree not to hold Canada Pacific District NYI, or any of their staff or leaders, involved in this event liable for accident, injury, illness, or death caused to the above-named child during his/her attendance and participation in “Encuentro Missions - Toronto 2027". In case of an emergency, I give permission to the adult leaders to take necessary action to ensure the best possible care for the above-named child. In the event that I cannot be reached, I give permission for medical care in a hospital.

Please select 'Yes' if you agree to the following statement:
—Please choose an option—Yes, I agree
By participating in "Encuentro Missions - Toronto 2027" you consent to, photography, audio recording, video recording of said event and activities within; and its/their release, publication, exhibition, or reproduction to be used for live streaming, promotional purposes, advertising, inclusion on web sites, and/or any other purpose by the Canada Pacific District Church of the Nazarene and/or its' Churches.

Please select 'Yes' to confirm that you have read and understand the CPDNYI Code of Content below.
—Please choose an option—Yes, I have

Parent or Guardian:
If you are registering as a leader just use your own name for the parent/guardian info

Name:

Relationship to child:

Signature of Parent/Guardian:
(Please sign your name in the box below with your mouse, or finger on a phone or tablet.)

Signature of Student:
(Please sign your name in the box below with your mouse, or finger on a phone or tablet.)

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