the brochure

CONSENT & RELEASE OF LIABILITY
We, the undersigned parent(s) or legal guardians for
Student Name
_______________________________
do hereby
release, forever discharge and agree to hold harmless
Willingdon Church and the representatives thereof from
any and all liability, claims, or demands for personal
injury, sickness, or property damage and expenses of
any nature whatsoever which may be incurred by my
CONTACT
information
child in the course of participation in the Riptide
All-Nighter on March 11-12, 2016.
I/We, the parents or guardians of the child named
above, undertake and agree to indemnify and hold
blameless the ministry staff, Willingdon Church, its
pastors and Board of Elders and Directors from and
against any loss, damage or injury suffered by the
participant as a result of being part of the activities of
Willingdon Church, as well as of any medical treatment
authorized by the supervising individuals representing
the church.
This consent and authorization is effective only when
participating in or traveling to events of Willingdon
Church.
We give authorization for the church to provide all
necessary food and transportation.
We give our permission for our child to participate in the
aforementioned activity, and for any representative of
the church to obtain necessary medical treatment. We
assume responsibility for any medical bills incurred.
Should our child have to return home before the group
for medical or disciplinary reasons, we hereby assume
any costs incurred.
Pastor Mark Janzen
[email protected]
Lauren Opelka
Ministry Associate
[email protected]
Rebecca Friesen
Administrative Assistant
[email protected]
RIPTIDE MINISTRY
Willingdon Church
4812 Willingdon Ave
Burnaby, BC V5G 3H6
p 604.435.5544
f 604.435.1186
Print Parent/Guardian Name:_____________________
Parent/Guardian Signature:_______________________
Emergency Contact:
Date:________________________________________
778.554.2364 (Mark Janzen)
This number is to be used for
emergencies only.
All-Nighter
I/We, the parents or guardians of the child named
above, authorize the ministry staff of Willingdon Church
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.
It’s time again for the annual Riptide All-Nighter!
Kick off spring break right with a whole night of
fun, food, and adventure. This event is open to
all students in grades 8-10 who want to come,
so bring your friends and pack the buses full!
what:
where:
go time:
end time:
cost:
you need to:
The Schedule
8:00-8:30 pm
8:30-9:30 pm
10:00-12:00 am
12:15-1:30 am
1:45-3:00 am
3:30-5:30 am
6:00-8:00 am
8:00 am
Check-in
Games & God Talk
Swimming
Gym Games / Open Gym
Pizza Buffet @ Me N’ Ed’s
Laser Tag & Rock Climbing
Movie @ the church
Go home and sleep
This is an entire night of sweet
activities, crazy things to do, and
good times to be had.

Have your parent/guardian fill out both
sides of the attached All Nighter registration
form.

Return your form to the church along with
your payment of $25. Cheques can be
made out to “Willingdon Church”.

Register by March 3rd by dropping your $$$
and form at the church office or the Sugar
Shack in the YC on Sundays/Thursdays.
Name: ___________________________________
Grade _____ School _______________________
Gender: Male or Female (circle one)
Phone # (_______) _________ - ______________
City_______________________________________
Postal Code_______________________________
Name of Parent or Legal Guardian
8:30pm on Friday, March 11.
Check-in is at 8:00pm!
Meet in the Youth Centre.
$25 includes all activities, a pizza
buffet at Me N’ Ed’s and your
transportation via chartered
school bus!
All-Nighter
Address __________________________________
Meet at Willingdon Church
4812 Willingdon Ave, Burnaby BC
8:00am Saturday morning.
Pick-up @ the Youth Centre.

The Details
___________________________________________
Who invited you? __________________________
bring:
dobrinotng:
rules:
Swim suit & towel, athletic attire, a
great attitude and all your energy!
Blankets, drugs, alcohol, energy
drinks or weapons of any sort.
Note: Electronics or other valuables
are brought at your own risk.
It’s all about RESPECT:
 RESPECT God
 RESPECT the leaders
 RESPECT each other
 RESPECT the facilities
Any instances of disrespectful behaviour
including fighting, bullying, the use of drugs,
alcohol, or weapons will not be tolerated
and will result in a quick call home.
Any medical conditions/concerns:
(i.e. health conditions, allergies, medications,
physical impairments or medical
requirements that we should know about.)
___________________________________________
___________________________________________
Care Card #_______________________________
Emergency Contact
Name:____________________________________
Phone Number:____________________________
*Parents: Don’t forget to sign the back of
this form!