Creation Connection - Artaban 2022

• *

  This form must be filled out by a parent or guardian, (or if the participant is over the age of 18, they may complete it with out parental consent). Are you 19 years or older?

  • Yes
  • If no, please pass this form to a Parent or Guardian and begin again.
• Name of Parent or Guardian completing form and relationship to participant if applicable - After this question, the rest of this form is for the participant:
• * First Name:
• * Last Name:
• * Date of Birth: DD/MM/YY:
• * Address 1:
• Address 2:
• * City:
• * Province:
• * ZIP Code:
• * Email Address:
• * Confirm Email Address:
• * Phone:

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  Event fee	$150.00 CAD

Emergency Contact Information

• * Emergency Contact 1: Name, Relationship & Number
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• * Emergency Contact 2: Name, Relationship & Number
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Participant Information

• * Badge Name:
• * Pronouns (shown on name badge) and Gender (not shown on name badge)
• * Dietary Requirements EG: Vegetarian:
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Medical & Other Information

• *

  Are you attending as a participant or as a leader or chaperone? (Leaders and chaperones take on extra responsibility in connecting with participants and helping the organizers ensure that the event runs smoothly. Please choose the option that best describes your role for this event:

  • Participant - Youth (12-18)
  • Participant - Young adult (19+)
  • Leader - Youth
  • Leader - Young adult
• *

  Under the Diocese of New Westminster's Screening in Faith policy, all leaders are required in the Diocese of New Westminster to have a valid Police Records Check (PRC) with Vulnerable Sector Check (VSC) every five years. Do you have a current PRC on Diocesan Record? If not please contact the Screening in Faith Facilitator for more information prior to the retreat: (email: SiF@Vancouver.Anglican.ca)

  • Yes - Leader
  • No - Youth
  • No - Leader - If a suitable PRC is not on record or provided, leader may be denied access to weekend
• * PHN/Care Card Number:
• * Family Doctor (Name, Practice & Contact Number):
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• * Medical or Dietary Restrictions/Allergies? Please give as much detail as possible including severity of allergy and medication if needed.
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• * Will you or your child be carrying any medication? If so, please provide as much detail as possible at to what the medication is and whether it is self-administered or if you or your child will need assistance.
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• Is there any further information that will help the leadership of the Retreat support you/your child over the course of the weekend? Please provide details:
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• Which parish Church do you attend? (N/A is fine.)

• How did you hear about this event?

  • Church
  • Youth Group
  • DYM Event
  • DYM Email
  • Word of Mouth
  • Other

Transport, Consent & Waiver:

• Release of Liability Waiver: Must be completed by persons of the age of 19 or older, or the parent or guardian of persons under 19: In Selecting "Yes" below, You acknowledge and agree that all reasonable precautions for the safety and health of the participant will be taken. Participants will be properly supervised in all activities. In the event of accident or illness, the Anglican Diocese of New Westminster, Diocesan Youth Movement, Camp Artaban, its staff and volunteers are released from any liability. In the event of injury or illness requiring medical attention, I authorize treatment for the participant and understand that reasonable attempts will be made to contact me, should such a situation occur. The participant must be covered by provincial health insurance or equivalent medical coverage.

• *

  In writing your name at the top of this form, all parties acknowledge and agree that Liability is released via electronic signature in selecting "Yes" below.

  • Yes
  • No - If no you or your child will not be able to attend the retreat

• Photo Release: Must be completed by persons of the age of 19 or older, or the parent or guardian of persons under 19: In Selecting "Yes" on this form, You acknowledge that the organizers of this event, Diocese of New Westminster, Diocesan Youth Movement, Camp Artaban, will be taking photos of this event for use on websites, in publicity materials and in related publications, such as newsletters. We will also have a videographer on site who will be taking a record of the event and acquiring material which may appear on organization websites and that may be shared at events such as Synods. By signing this release, you permit the Diocese of New Westminster to use your name and photograph in all forms of media which may result from the event and waive the right to approve the finished product.

• *

  In writing your name at the top of this form, all parties acknowledge and agree that Photo permission is given via electronic signature and selecting "Yes".

  • Yes
  • No
• * Is there a person(s) that the participant would like to share a cabin with? Is there any other needs you have regarding room arrangements?
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• There is an option to bring your own tent rather than stay in a cabin. Would you prefer this option?

  • Yes
  • No
• If you prefer to tent, you will need to bring your own camping/tenting equipment. Do you have all the necessary equipment for tenting/camping?
• Is there anything else you think we need to be aware of for this event?
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• Thank you for completing the registration form. We appreciate you attention to detail in filling out this form, and if you have any more concerns or questions regarding this event, please email jschaap@vancouver.anglican.ca or call the Diocese of New Westminster at 604-684-6306. Thank you! We are looking forward to seeing you or your child at this event!