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INFORMED LETTER OF 

CONSENT


DISTURBING THE PEACE

April 19-21st, 2024


Disturbing the Peace: April 19-20 2024

Details of Activity: Friday, April 19 - Sunday, April 21, 2024, at Grande Prairie Alliance Church. During this event, students will be participating in worship, rallies, games, and small group discussions. Cost includes students' tickets, meals (Saturday breakfast, lunch and supper, and breakfast on Sunday), and transportation between McLaurin Baptist Church and Grande Prairie Alliance Church. Our group will be staying at McLaurin Baptist Church in Grande Prairie for the nights. Please bring anything you might want for sleeping on the floor of the church. We will meet at McLaurin at 5 PM on April 19th. Parents will need to pick up their students from Grande Prairie Alliance Church on April 21st at 12:30 PM. 

Price Breakdown:

Early Bird - $135 Until Feb 28th

Regular Price - $145 Until April 10th

Registration closes on April 10th, 2024, at midnight. 


Dear Parents

This activity is part of our programming and requires your permission prior to participation. The safety of your youth is our primary concern. Precaution will be taken for their well-being and protection. We request that you complete and sign the permission form.

While every precaution is taken for safety and good health, some sports and activities carry with them inherent risks. I/we understand and accept these risks and agree that by allowing the above-named youth to participate in those activities, he/she may be taking part in a recreational activity that presents the potential for personal injury. I/we, the parents or guardians named below authorize Nate Perry (Associate Pastor of Student Ministries) or one of the Beaverlodge Alliance Church staff/volunteers to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

I/we, named below undertake and agree to indemnify and hold blameless Beaverlodge Alliance Church, the ministry staff/volunteers, its Pastors, and the Board of Elders from and against any loss, damage, or injury suffered by the participant as a result of being a part of the Disturbing the Peace event, as well as of any medical treatment authorized by the supervising individuals representing Beaverlodge Alliance Church.

I have read, understand, and agree with the above. I hereby consent to the participation of my/our youth in the supervised activity

Today's Date: May 9, 2024 









First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Health Care Number *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Health Care Number *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Health Care Number *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Health Care Number *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Health Care Number *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Health Care Number *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Health Care Number *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Health Care Number *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Health Care Number *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Health Care Number *
Parent or Guardian's Email Address

Email*

Confirm Email*
Method of Payment
In the note of all e-transfers, please indicate it is for DTP 2023*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Health Care Number *
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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