*Denotes Required Field * Title * Youth Last Name: * Youth First Name: * Grade: Please select an option 9 10 11 12 * Gender: Please select an option Female Male Student Phone #: ( ) - Email to receive event info: * BC Care Card Number: * Any Medical Info we need to be aware of? (Type "no" if none) * Parents/Guardians Names: * Parent/Guardian Phone Number: * Emergency Contact Name (in case parent cannot be reached): * Emergency Contact Relationship to Student(s): * Emergency Contact Phone Number: WAIVER: In order for your registration to be complete, you will need to have a waiver signed for the Extreme Air Park. You will receive a response email when you complete this form - in that email you will find the WAIVER link, please fill it out asap. You can either print it and fill it out and then bring it to the church office, or fill it out online and then email it to youth@centralheights.ca. No waiver / payment = no spot reserved. * Do you agree to these terms? Please select an option Yes No MEDICAL RELEASE: I release Central Heights Church and its Youth Team from any liabilities incurred by my child while at the CHC High School All Nighter. In the event my child suffers sudden illness, accident, or injury, I give permission for any emergency treatment that is deemed necessary by a licensed physician. Every effort will be made to contact the parent or guardian prior to any emergency treatment. * I agree with the medical release IMPORTANT PAYMENT INFO (PLEASE READ): To complete your registration, you will be taken to our payment page. Your fee for the All Nighter is $80 until February 1 and $85 after. You will need to enter the correct amount on the next screen. On the payment screen you will also need to fill out your billing information. If you are paying for more than one student, you can pay for all students once, but each student will need the registration form filled out.
