EmergencyContact Information:

Medical/Allergy Information (if applicable):

Date:
Parent/Guardian's Name:
Parent/Guardian's Signature:
Participant's Name:
3. DYes OR[]No (select one only) - I grant Beee permissionto usephotos of my child taken
during the above activity for BeeCwebsite, bulletin board, presentation, and/or newsletter.
(Note: B C eewill never reference your child by name or provide any specific information
regarding your child. B ece will never self thesepictures. Thepictures will only be used
exclusivelyfor the purposes of internal record-keeping and promotion of B cce activities.)
2. I authorize the activity supervisor(s) in whose care mychild hasbeen entrusted, to seekon
my behalf anyemergency medical treatments deemed necessarybythem for whatever
reasonduring the above activity should, in their discretion, the need arise. I agreeto fully
financially responsible for anysuchmedical treatment or emergency services andagreeto
reimburse HCCefor any costs they mayincur asa result.
1. I give my permission for my child to attend and participate in the above activity. I assumeall
risksand responsibilities on behalf of my child associatedwith the participation inthe above
activity andtravel to andfrom this activity, including personal injury, sickness,death,
damage, and expense. I hereby releaseand discharge BurnabyChrist Churchof China(BCCC)
andits staff andvolunteers from any liability arisingthereby.
Activity Information
Date:
Time:
Venue:
Contact Person:
Details:
Parental/Guardian Consent Form
.if- '* ~ttf u iL tf -* * if ~i 11
BURNABY CHRIST CHURCH OF CHINA
........._,'-'--'...J ...U-.J J L Ul.l.ltl:...::l.r~'iI '!..~U 6580Thomas Street, Bu rnaby,B.C., Canada. V5B 4P9 Tel: (604)299-1170
July 12, 2014
6:30pm
Deer Lake
Wesley Chin
Canoeing/kayaking/paddleboating
Meet at Deer Lake at 6:30. Will walk back to the
church when we are done.
Cost: $8