King's Community Church Parental/Guardian Consent Form and Liability Waiver For
Blizzard/Avalanche CBOQ Youth Retreat at Muskoka Woods
I ,__________________________ parent/guardian of ________________________ give
consent for my child to travel, and participate, with the Youth Group and Youth Leadership
Team of King's Community Church to Muskoka Woods for CBOQ's Youth Avalanche (Grades 68) Retreat January 15-17,2016 OR Blizzard (Grades 9-12) Retreat February 5-7, 2016.
COST: $131.00
Please specify which retreat your child is attending:
_______________________________________
In signing this consent form, I acknowledge that I have read and agree to the information
below:
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Students will NOT be allowed to leave Muskoka Woods unless travelling to and from the
venue with King's Community Church, or otherwise accompanied by a King's Community
Church youth leader with expressed parent consent for emergency purposes ONLY.
Students will travel to and from Muskoka Woods (4585 Highway 141, Rosseau Ontario,
Canada) using group transportation (bus rental in collaboration with other churches in
the area)
Students will have access to the Muskoka Woods, the ability to play several winter and
indoor athletic games/sports, and various other games
Students will pack according to the list to come, for two nights keeping in mind the cold
weather and being outdoors.
Students will be required to adhere to all the safety rules of King's Community Church,
the CBOQ, and Muskoka Woods for the duration of the weekend, students who do not
adhere to these rules will not be able to participate (and may possibly be sent home at
own expense).
In signing this CONSENT FORM, I acknowledge that I DO NOT, in any way, hold King's
Community Church or their youth leadership team financially responsible for any injuries that
may occur within the activities during the retreat or while travelling to and from Muskoka
Woods.
In signing this CONSENT FORM, it is the understanding that all students will represent
themselves, and King's Community Church, in an appropriate manner; and the payment of any
additional damage fees will NOT be the responsibility of King's Community Church, but that of
the student(s) involved.
In signing this CONSENT FORM, I agree that in the event of my child’s inappropriate behavior,
deemed serious enough by our youth leadership team; my child may be sent home at my own
expense.
In signing this CONSENT FORM, I agree that in the event of an injury or serious medical
situation, the leaders of King's Community Church are able to take the necessary steps to
ensure the well being of the participant. This includes but is not limited to transportation to and
from the hospital and/or administering first aid.
Emergency Contact Information:
1. Name: __________________________________________
Relationship to Youth: ______________________________
Home Phone Number: ____________________________
Alternate Phone Number: _________________________
2. Name: __________________________________________
Relationship to Youth: ______________________________
Home Phone Number: ____________________________
Alternate Phone Number: _________________________
Student/Participant Information & Registration Camp Meals/Medicine Information: Does
your student have any specific food allergies or medications that we, as leaders/chaperones of
your children, should be aware of? YES NO If so, please specify:
______________________________________________________________________________
______________________________________________________________________________
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Parent/Guardian Signature: ______________________________________________________
Once you have completed this registration form as well as additional forms from the CBOQ and
Muskoka Woods (included) please attach a cheque made out to King's Community Church with
the corresponding retreat date and name of student in the memo line. You can hand in your
forms and cheque to the church office or to Chris Weir - Youth Associate, King's Community
Church.