three60five2025 – Registration Form

Registering As...*

Name*

First Last

Grade*

Gender*

Address*

Street Address / Box No. 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)?

The Youth Pastor/Leader from this group may be notified of your registration to help them in their planning for three60five.

Roommate Preference

(1 name only, no guarantee)

List Medical Concerns

Health Card #

List Allergies

Please note: due to the limited capacity of our kitchen, we may not be able to accommodate all food allergies; if you have food allergies that we are unable to accommodate, you will be contacted following the form submission to discuss options.

Payment Amount*

(Price includes GST)

Payment Method*

Registrations will not be considered complete until payment has been received.

Consent*

Understanding that the employees of Nipawin Bible College will act according to their best judgment to ensure the health and safety of all participants, I hereby release Nipawin Bible College and all people associated with three60five2025, from legal liability for any injuries or illnesses involving the registrants while at three60five2025. I understand the registrant is expected to conduct him/ herself in a manner conducive for Christian fun and spiritual growth. I accept that the leadership of three60five2025 and Nipawin Bible College reserves the right to correct and/or send a registrant home at his/her own expense. I also acknowledge and agree to allow my name, photograph and/or quotes from three60five2025 to be used by Nipawin Bible College in future promotional material.

If you are 17 years and under, a parent/guardian must complete the following:

I have read, understand, and will adhere to the contents therein.

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

Other

Is there anything else, not covered in this registration form, that we should know?

Name

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

three60five2025 – Registration Form

Registration Form

three60five 2025

Contact Information