PRIVACY POLICY

In order to ensure your safety and the safety of others, we need to collect some basic information including (but not limited to): your current contact information, medical information and allergies. We understand the sensitive nature of this information, and every effort will be made to ensure its complete confidentiality. The information we collect in this package will be viewed solely by the ministry staff within our organization (XLR8 Youth) and our parent organization (Gateway Alliance Church). If necessary, this information we be shared with licensed medical professionals, including (but not limited to) nurses, paramedics and doctors, as outlined in our liability waiver below. Under no circumstances will any of this information be shared with a third-party without your consent, unless required by law.

By signing this release, you acknowledge that you have read these terms and give consent for the information collected to be used in accordance with this privacy policy.

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This Permission Form is valid for the 780 Conference taking place from February 7 - 8, 2020

Download Paper Form: xlr8.ac/780-conf
To download, please copy this link & paste into a tab in your browser


Review XLR8 Youth's Privacy Policy

780 Conference 2020
(Valid for the 780 Conference happening from Feb. 7 - 8, 2020)

 

WHAT IS IT
We are so excited to be partnering with the 780 Network for the first ever 780 Conference! This is going to be an amazing two day event with hundreds of youth from across Edmonton gathering together to worship, learn & encounter God – and of course, to play some epic games, win some sweet prizes, and hangout with incredible people!

This event is being hosted at West Edmonton Christian Assembly, and is a paid event that requires registration.

 

WHEN IS IT
Friday, Feb. 7 - Saturday, Feb. 8, 2020
Dropoff & pickup times (Friday & Saturday) will be announced shortly.

 

WHERE IS IT
Pickup & dropoff will be at Gateway Alliance Church (13931 140 St NW, Edmonton), with the event
taking place at West Edmonton Christian Assembly (6315 199 St NW, Edmonton).
We will be bussing to and from this event.


WHO CAN COME
All youth grades 6-12! 


COST
Price is $50 per person. This price covers the cost of registration for the event, transportation and lunch & dinner on Saturday.
We will not be providing lodging for this event.

First Student's Name

First Name*

Last Name*
First Student's Date of Birth*
First Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
First Student's Signature*
Second Student's Name

First Name*

Last Name*
Second Student's Date of Birth*
Second Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Third Student's Name

First Name*

Last Name*
Third Student's Date of Birth*
Third Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Fourth Student's Name

First Name*

Last Name*
Fourth Student's Date of Birth*
Fourth Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Fifth Student's Name

First Name*

Last Name*
Fifth Student's Date of Birth*
Fifth Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Sixth Student's Name

First Name*

Last Name*
Sixth Student's Date of Birth*
Sixth Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Seventh Student's Name

First Name*

Last Name*
Seventh Student's Date of Birth*
Seventh Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Eighth Student's Name

First Name*

Last Name*
Eighth Student's Date of Birth*
Eighth Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Ninth Student's Name

First Name*

Last Name*
Ninth Student's Date of Birth*
Ninth Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Tenth Student's Name

First Name*

Last Name*
Tenth Student's Date of Birth*
Tenth Student's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent/Guardian Information

Full Name *

Relationship to Student: *

Phone Number *
If you would like to receive occasional monthly updates about XLR8 Youth's events, please select the which method(s) you would like below.
Email Updates
SMS Text Updates
Need sponsorship for this event? Simply check the box below & we will cover your cost!
Yes, I require sponsorship
Emergency Contact Information

Please note- in case of emergency we will first contact the parent/guardian listed above. If they are not available, we will contact the emergency contact listed here.


Emergency Contact Name *

Relationship to Student: *

Phone Number: *
Assumption of Risk & Liability

​Please Read Carefully!


By signing this release, you acknowledge that you understand and appreciate the inherent and other risks involved in your child/children's participation in the 780 Conference, and certify that you have determined that your child/children is/are in good health and suitable to participate in the aforementioned events. Should your child/children become ill, or if deemed necessary by the church or its agents due to noncompliance with the above basic rules of conduct or list of expectations, you also agree to bring your child home at your own expense.

By signing this release, you acknowledge that Gateway Alliance Church, XLR8 Youth and the 780 Network cannot ensure your child/children's safety, and choose to voluntarily allow your child/children to participate in this/these events despite all risks. You furthermore certify that you are competent and have read and understood this agreement and are signing it voluntarily; and that you have discussed these risks and dangers with your child/children attending this event; and hereby now and forever release Gateway Alliance Church, XLR8 Youth, the 780 Network and its employees, volunteers and agents from any and all liability claims you or your child/children may have for any injury, illness, disability, emotional distress, damage or loss of personal property relating to your child/children's participation in this event, whether described in this document or not.

Furthermore, by signing this release, you acknowledge that this agreement has no expiration date and remains in effect before, during, and after these events. Should any portion of this agreement be found invalid, you acknowledge that the rest shall continue in full force and effect.

In consideration of Gateway Alliance Church, XLR8 Youth and the 780 Network allowing your child to participate in the 780 Conference, you furthermore agree to the following:

  1. Photo Waiver: Gateway Alliance Church and XLR8 Youth may take and use photographs, video, and other images of yourself and your child/children participating in the 780 Conference or any other XLR8 Youth event. You waive any right to privacy, compensation, copyright, or other rights to those images, and consent to Gateway Alliance Church and XLR8 Youth using those images for promotional purposes.
  2. Transportation Waiver: For this event, Gateway Alliance Church and XLR8 Youth will be transporting your child/children in safe, well maintained busses supplied by a local licensed bussing company. By signing this release you indicate that you and your child/children are aware of the inherent risks involved in transportation over public roads, and release Gateway Alliance Church, XLR8 Youth and its staff, volunteers, and agents from any and all liability that may occur during the course of transportation for this event.
  3. Medical Waiver: In the event that your child/children require(s) medical treatment during this event, every reasonable effort will be made to contact you and/or the emergency contact listed above. Should your child/children require medical attention, you consent to any reasonable medical treatment as deemed necessary by a licensed physician; and acknowledge that you will be ultimately responsible for the cost of any medical care. Furthermore, you certify that all the medical information contained in this form is up-to-date and valid. As necessary, you also acknowledge and authorize the use of first aid by a person holding valid certification, as well as the use of CPR.
  4. Communication Waiver: By signing this release, you authorize Gateway Alliance Church, XLR8 Youth and its employees and volunteer leaders to communicate with your child/children now and in the future via email, text, and other social media platforms (Facebook, Instagram, Messenger, etc ) in accordance with our Social Media Policy (available on request) for the following reasons: to inform your child/children about upcoming youth events & registration deadlines, to respond to any messages your child/children may send XLR8 Youth & it's leaders, and to connect with your child/children in order to build deeper leader-student relationships.

By checking yes below & furthermore by signing this form, you acknowledge that as the legal guardian of the child/children named on this form, you have read the rules of conduct, have discussed them with your child/children, and grant permission for the child/children to participate in this event according with the policies listed above. *
Yes, I have read the terms and conditions outlined above
Youth Expectations

  1. At no time are any youth allowed to leave the West Edmonton Christian Assembly premises without a leaders consent or knowledge. ​This is a homeward-bound rule.
  2. Everyone is expected to respect and listen to all leaders that you encounter during this trip, as well as the other youth that you are with.
  3. Please make sure to honor and respect all facilities, vehicles and properties that you are visiting throughout this event.
  4. Bullying will not be tolerated.
  5. There will be no alcohol or drugs permitted of any kind.

By checking yes below & furthermore by signing this form, you acknowledge that you will review these rules with your child/children before this event, and that your child/children's failure to follow these rules will result in them being sent home, and that you will be responsible to pick up your child. If you are unable to pick up your child, a suitable ride will be determined at your expense. Remember, there are no refunds if your child must be picked up. *
Yes, I have read the above rules & will review them with my child/children
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Grade in the Fall:*
Gender:*

Email Address

Phone Number

MEDICAL INFORMATION


Health Card # *

Please list all the students known allergies, and any medication they may bring

Please list all known health conditions which may affect their participation in this event
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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