Register by March 31
FULL NAME
Your answer
MOBILE #
Your answer
HOME ADDRESS
Your answer
DATE OF BIRTH
MM
/
DD
/
YYYY
EMAIL ADDRESS
Your answer
FOOD ALLERGIES?
Your answer
EMERGENCY CONTACT #1 NAME
Your answer
EMERGENCY CONTACT #1 TELEPHONE
Your answer
EMERGENCY CONTACT #2 NAME
Your answer
EMERGENCY CONTACT #2 TELEPHONE
Your answer
MEDICAL REQUIREMENTS? (i.e. diabetic or allergies etc.)
Your answer
The cost for this conference is $150 per person.
Please remit your payment by cash or cheque to one of the youth leaders (Jack or Kevin)
If you require financial assistance we will help, please check this box.
VERY IMPORTANT IF YOU ARE UNDER 18 YEARS OF AGE
If you are under the age of 18, please download all 4 forms that are listed below, print them, have your parents fill them out, sign them and bring them in to the church by Friday March 31.

IMPORTANT - All 4 of the following forms MUST be completed.

Form 1 - www.vitamint.ca/REGISTRATION_UNDER_18.pdf
Form 2 - www.vitamint.ca/PHOTO_CONSENT.pdf
Form 3 - www.vitamint.ca/PERMISSION_LETTER.pdf
Form 4 - www.vitamint.ca/SEARCH_FORM.pdf

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