Gospel Centre Overnight Permission Form (Fall Stay In Retreat 2026)

Event Date: November 13-14, 2026
Location: Gospel Centre Church
Individual(s) in Charge: Pastor Gabriel Banaag
Drop Off: November 13 - Doors Open at 6:30pm
Pick Up: November 14 at 8:15 pm after the evening service at Gospel Centre
Student Cost: $30 (includes meals/snacks/prizes)
Registration Deadline: Friday, November 6

Student's Information

Name of First Student

Name of Second Student

Name of Third Student

Address

Alberta Health Care #

Alberta Health Care # of Second Student

Alberta Health Care # of Third Student

Grade

Grade (2nd Student)

Grade (3rd Student)

School

School(s) of 2nd/3rd Student(s)

Gender

Female Male

Gender (2nd Student) Female Male

Gender (3rd Student) Female Male

Allergies - Does this student(s) have any allergies or dietary issues that we should be aware of? Please list them below and specify which student:

Do you/they have any special instructions or physical, emotional, mental, or behavioral concerns/limitations for this student that we should be aware of (please specify which student)?

My Student(s) Will Be Staying Overnight

Student Will Be Staying Overnight I Will Pick The Student Up at 11:30PM Friday Night, and Will Bring Them Back at 8AM Saturday Morning

Please add additional comments if student is not staying overnight (Write "N/A" if student is staying overnight).

Parent/Guardian's Information

First Parent/Guardian's Full Name

First Parent/Guardian's Cell Phone

First Parent/Guardian's Email

This address will receive a confirmation email

Address (if different than above)

Second Parent/Guardian's Full Name

Second Parent/Guardian's Cell Phone

Second Parent/Guardian's Email

For the Student

Youth Group Policy for Events (PLEASE READ CAREFULLY) *On outings you represent our church, youth group, friends and families and most importantly Jesus Christ. Your actions show your character. Please be appropriate. *The use of drugs or alcohol, any infractions of the law, weapons, sexually related activities, fighting, cussing, vandalism, pranks & disrespect of authority will not be tolerated at any Gospel Centre Pentecostal Church Youth Group activities. *During sleep over events youth are required to stay in designated areas and no other friends are allowed to visit. *Any youth who is 18 years or older and is still participating in the youth group as a youth is required to follow all the rules of a minor. *If a specific individual(s) is identified who has broken this policy, they will be asked to leave the function. If individual(s) cannot be identified then the function will end and everyone will be asked to leave. *PDA is not acceptable at any time while on youth group events or activities. Dating couples should remember to set a Christian example to everyone. Physical contact should be kept to a minimum. Holding hands is the limit of PDA that is allowed of all in the youth group. Audio players and video games may be allowed on extended trips (i.e., anything over seven (7) hours). Absolutely nothing may be played or listened to that is questionable. Phones will be taken for safe keeping during our times of worship and listening to our speaker. If our leadership notices anything that will distract or take away from the retreat experience, these students will be requested to be picked up by their parent/guardian. *Clothing should be modest at all times. That is, if you have doubts about what you are wearing or taking to wear, it is probably not acceptable. No showing of anything that is normally covered by clothing will be accepted at any time. If in doubt about appropriate clothing, please first check with your parents or if already in attendance at an event or activity, check with an adult chaperone.

Signature of First Student

Signature of Second Student

Signature of Third Student

Date Signed

General Info, Permissions & Legal Consent

Parent/Guardian Signature

Date Signed

WAIVER: My child has permission to participate in all activities under the supervision of Gospel Centre Pentecostal Church Youth group chaperones. My child may also ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Gospel Centre Pentecostal Church. I further grant permission for my child to be examined by a physician or nurse in case of accident or illness if taken to an emergency room. I understand I will be contacted immediately. My Child also has permission to be a part of this offsite/overnight event. I understand that my child will be expected to adhere to the rules and regulations of the youth group. Failure to do so may result in dismissal from the activity. I understand that there may be potential for injury (minor or severe), broken and/or stolen personal belongings while participating in this event, and I will not hold Gospel Centre Church or any of the staff or volunteers liable for any of the potentials listed above. *

I have fully read, understand, and agree to the terms of the waiver

Parent/Guardian Signature

Date Signed

WAIVER: I hereby give permission for my child to be photographed and/or filmed without any reimbursement of any kind due to me or the need to pay any fee. Gospel Centre Pentecostal Church considers all information personal and confidential and will only use it within the church for ministry or other church related activities and will not release it to outside parties or organizations.

Yes No

Parent/Guardian Signature

Date Signed

Emergency Contact Name

Emergency Contact Phone Number

Gospel Centre Pentecostal Church considers all personal information as confidential and will not release it to outside parties or organizations. However, by completing this form, you are providing consent for this information to be used within the church for ministry and other church related activities. when using photos of Gospel Centre events, either on our website or on Gospel Centre's Facebook page, we try to post photos that would not be considered objectionable. We will remove any photo immediately upon request.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Gospel Centre Overnight Permission Form (Fall Stay In Retreat 2026)

Description

Please Fix the Following