Faith Quest Registration 2017
First Name *
Your answer
Last name *
Your answer
Street Address *
Your answer
Province *
Your answer
Postal Code *
Your answer
Phone Number *
Your answer
Alternative Phone Number *
(Cell, work)
Your answer
Youth Email Address *
Your answer
Parent Email Address *
Your answer
Home Church *
(If none, please list none)
Your answer
Birthday *
(month-day-year)
Your answer
Grade *
If you are a leader attending with your Youth please indicate
Gender *
Which Gender identity/ies best fits you?
Your answer
Rooming Preference
Is there anything about your gender identity that you feel would help organizers to co-create a safe space in shared accommodation? Eg. Preference for own room or shared?
Your answer
Medical Issues or Alerts *
Please include any medical issues or challenges the leaders should know about as well as a list of medications you are taking and the severity of any allergies listed.
Your answer
Dietary Needs - egs. diabetic diet, gluten free *
Please ensure you list food allergies - indicating serious allergies and treatment if you have not already done so.
Your answer
Date of Last Tetanus Shot
Your answer
Parent/Guardian's Full Name (Required if under 18 years of age) *
If over 18 just put n/a in space please.
Your answer
Parent/Guardian Phone (Required if under 18 years of age) *
If over 18 just put n/a in space please.
Your answer
Parent/Guardian Mobile (Required if under 18 years of age) *
If over 18 just put n/a in space please.
Your answer
Emergency Contact Name *
Everyone required to provide this - provide alternative to parent/guardian in case contact cannot be made.
Your answer
Emergency Contact Phone Number *
Your answer
Information to Complete Registration
Thank you for taking the time to register for FaithQuest!

Please ensure to:

1. Send a cheque for $150 to VANYAYA, 1550 W 33rd Ave, Vancouver BC, V6M 1A7, or process your payment online to complete your registration and save your spot.
2. Contact us if you need help with funding - there are bursaries available!
3. Fill out the waiver and return it to us by mail or email.
4. Look for information via email!
5. Find the Facebook Page for this event via www.facebook.com/VanYAYAministry

We look forward to seeing you in January!

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