Youth Information
Birthday *
Sex *
Phone Number *
Phone Number
Mailing Address
Emergency Contacts
Name of Contact *
Name of Contact
Best Phone Number for Contact *
Best Phone Number for Contact
Medical Info
Does the person registering have any special physical, emotional or behavioural, or dietary needs which may require special attention? If yes, please describe in detail, in areas below.
The leaders and organizers of LiftOff are granted permission for my child to receive any emergency treatment that may be necessary. I further release and forever discharge any organization involved in LiftOff, its representatives, leaders, servants, agents, employees from any and all actions, causes of action, claims and demands whatsoever, whether existing or which may in future arise over the operation of any activity associated with LiftOff and for transportation to and from the activity.
Parent/Guardian Name *
Parent/Guardian Name
The City Youth Event
Date Submitted *
Date Submitted
Checkbox *
By checking the box below, I am confirming that I, above stated parent/guardian, have read and consent to above stated release for above stated event of The City Youth.
Adult (19+) | Youth (Ages 13-18) | Child (Ages 12 + under)
The base price includes all transportation, Friday night kick-off, pool, pizza snack and meals (not including fast-food dinner on the way back home). Simply check the applicable box to calculate your personalized cost. Prices include taxes.
Rental Packages *
Calculate and enter your total cost (Base Registration Price + Lift Tickets & Rentals). All Tax is included.
Payment must be made to Peter Bird (The Meeting Place Youth Pastor) before Sunday, January 27th, either by cash or cheque (made out to Peter Bird).