Registration Form three60fiveJUNIOR2023 "*" indicates required fields Registering As...*Choose OneRetreaterYouth Sponsor/LeaderName* First Last Grade*Grade you will be entering Fall 2023Choose OneGrade 7Grade 8Grade 9Gender*Choose OneMaleFemaleAddress* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code PhoneEmail* Emergency Contact Name* First Last Emergency Contact Phone*Which church or youth group are you coming with (if applicable)? Roommate Preference(1 only, no guarantee) List Medical ConcernsHealth Card # List AllergiesPayment Amount*Choose One$115 Retreater Late Fee (After September 22)$75 Youth Leader FeePayment Method*Registration is not considered to be complete until payment has been received. Cheques must be postmarked on or before Sept. 22 in order to receive the early bird fee.Choose OneSending e-transfer to finances@nipawin.orgMailing a cheque (Nipawin Bible College, Box 1986, Nipawin, SK S0E 1E0)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 three60fiveJUNIOR2023, from legal liability for any injuries or illnesses involving the registrants while at three60fiveJUNIOR2023. 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 three60fiveJUNIOR2023 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 the three60fiveJUNIOR2023 to be used by Nipawin Bible College should they be used 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* EmailThis field is for validation purposes and should be left unchanged. Δ