The Pause - Youth Retreat 2019 Registration:
Event Dates: Feb 15-17, 2019
Event Location: Red Rock Bible Camp
Contact us at (204) 792-4225 or matt@nessbaptist.com
Email address *
Name of student *
Your answer
Parents/Guardian's names *
Your answer
Address: *
Your answer
Age group? *
Required
T-Shirt Size (Adult Sizes) *
Dietary restrictions *
Primary emergency contact person: *
Your answer
Primary emergency contact phone number: *
Your answer
Relationship to emergency contact person: *
Your answer
Alternate emergency contact person *
Your answer
Alternate emergency contact person phone number: *
Your answer
Relationship to alternate emergency contact person: *
Your answer
Health registration number - 6 digit *
Your answer
Personal health number- 9 digit *
Your answer
Name of family physician *
Your answer
Additional family health plans or benefits:
Please include any necessary information for your plan.
Your answer
Allergies, special conditions, or medications:
Please list any allergies, special conditions or medications that we should be aware of.
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By registering for this retreat you must also agree to sign the required waiver form linked on our website and hand it in to Pastor Matt. By checking the box below you are agreeing that you have or will fill out the required waiver form. *
Required
Payment Options:
We accept cash or cheques written out to Ness Baptist Church with "Youth Retreat" in the memo line. In the new year, we hope to have the ability to process credit and debit transactions. If you have registered by Jan 31st, the cost is $85.00. If you registered on or later than Feb 1st, your cost is $100. If you need some financial assistance and would like to apply for one of our student scholarships please register and talk to Pastor Matt about the fee later. We do not want a student to miss out on the retreat because of money. We want each and every youth to be able to come on our retreats, so please don't hesitate to ask for a scholarship.
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