DOXA JR 2026 – Registration Form – Nipawin Bible College

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URL

This field is for validation purposes and should be left unchanged.

Registering As...*

"Youth Sponsor/Leader" refers to the adult individual(s) bringing along a group of youth, typically a youth leader, youth pastor, or individual designated by a church to chaperone the youth attending DOXA JR.

Name*

First Last

Grade*

Grade you will be entering Fall 2026

Gender*

Address*

Street Address Address Line 2 City Province Postal Code

Phone

Email*

Emergency Contact Name*

First Last

Emergency Contact Phone*

Which church or youth group are you coming with (if applicable)?

List Medical Concerns

Health Card #

List Food Allergies

Due to the limitations of our kitchen, we are unable to accommodate some dietary restrictions. If special arrangements need to be made, we will reach out to you after receiving your registration form to determine what must be done. Please note the severity of your allergy.

Payment Amount (Retreater)*

Payment Amount (Youth Sponsor)*

Payment Method*

Registration is not considered to be complete until payment has been received. e-Transfers must be received BEFORE 5pm, Sept. 18 in order to receive the early bird fee. NOTE: in-person payment must be done prior to the event and can NOT be completed upon arrival.

Parent/Guardian/Adult (aged 18+) Name*