🙏 YTOL May Retreat 2017 🙏
Please fill this out in all the required spaces. The online registration and payment due date will be posted at a later date!
Feel free to email ytolcanada@gmail.com or Facebook message YTOL Canada with any questions!
Full Name *
Your answer
Date of Birth *
Address *
ex. 135 Smith Road, Toronto, ON
Your answer
Home Phone Number *
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Cell Phone Number *
Your answer
Email *
Your answer
Health Card Number *
Your answer
Allergies/Medical/Dietary Restrictions *
Are there any allergy, medical or dietary concerns we should be aware of? If no, put N/A.
Your answer
Emergency Contact *
Full name + Relationship
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Emergency Contact # *
Phone Number
Your answer
Is this your first YTOL Retreat? *
Can YTOL use photos of you from the retreat? *
Photos will be used on the various online media such as Facebook or YTOL's website.
I the undersigned (if participant is 18 years of age or older) or parent/guardian of the above listed minor participant, acknowledge and fully understand that each participant will be engaging in activities that there may be other unknown risks not reasonably foreseeable at this time, assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death, hereby release, discharge, covenants to indemnify and not to sue Youth Teams of Our Lady or any of the Organizers or its affiliated organizations and sponsors. I hereby give my consent to have a doctor of medicine or dentistry or associated personnel to provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I, also agree to save and hold harmless and indemnify each and all parties herein referred to above as release from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed upon said release because of any defect in or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the negligence of the release. I have read the above waiver/release and understand that (I) we have given up substantial rights by signing this release and sign below voluntarily. I understand that this document may not be altered in any manner and that any alternation without the express written consent from the Youth Teams of our Lady will cause the participant to be removed from the retreat at any time. *
After reading, type: I understand. (Your full name)
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