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Participation Requirements / Liability Waiver
Retreat Reservation
RETREAT RESERVATION
Name of Parent completing this Reservation:
Number of Guests (up to 5):
Length of Retreat:
Full Overnighter (Evening, Morning, Afternoon)
Short Overnighter (Evening and Morning)
Evening Only
Morning Only
Morning and Afternoon
Preferred Starting Date of the Retreat:
Accommodations:
Private Guest Suite
Private Campsite
Your comments...
Choose a Primary Activity:
-
Forest Trails and Creek
Kayak / Canoe
Outdoor Rappel
Outdoor Rock Climb
Indoor Rock Climb
Fly Fishing (instructor and rods included)
Caving
Abbotsford Drop-In Center (Pool, Foosball, Video Games)
NO THANKS. NONE OF THE ABOVE
Backup Primary Activity:
Forest Trails and Creek
Kayak / Canoe
Outdoor Rappel
Outdoor Rock Climb
Indoor Rock Climb
Fly Fishing (instructor and rods included)
Caving
Abbotsford Drop-In Center (Pool, Foosball, Video Games)
NO THANKS. NONE OF THE ABOVE
Other Activities you may choose:
Home Foot Spa
Board Games, Cards, Air Hockey
Explore Forest Trails and Silver Creek
Beach and Shallow Swim at Silver Creek
Campfire
Spiritual Reflection in Forest
Coffee Shop and Donuts ($10 gift card provided)
Fun Team Building Games
Nintendo Wii
Movies (DVD and Netflix)
Please describe your purpose for this retreat:
Select a topic you may wish to help your child with:
-
Parent and Child Communication
Family Conflict and Youth Independance
Fathers Helping Sons with their Masculinity
What Every Girl should know about Guys
Dating Relationships
Faith and Meaning of Life (from a Christian point of view)
Self-Esteem
Peer Pressure
Puberty
World Poverty and Compassion Video
NO THANKS, NONE OF THE ABOVE
Is there another topic above that you would like to address?
Has the participating PARENT(S) read and agreed to the "Participation Requirements" and "Liability Waiver"?
Yes
No
Does the participating PARENT(S) have any unresolved drug or alcohol addictions?
Yes
No
Does the participating PARENT(S) have a history of physical or sexual abuse toward children or youth?
Yes
No
Does the child(ren) have more than one guardian/parent?
Yes
No
NON-Participating PARENT/GUARDIAN'S Name:
Does the NON-participating PARENT/GUARDIAN understand and agree to the "Participation Requirements" and "Liability Waiver"?
Yes
No
N/A
Where did you hear about Youth and Parent Adventure Retreats?
General Comments concerning your retreat or the above questions:
Home Phone:
Cell/Work Phone:
Email:
Address:
City/Province:
Postal Code:
1ST GUEST'S FIRST/LAST NAME:
Parent or Child:
Parent
Child
Gender:
Female
Male
Date of Birth:
Care Card (Medical #):
Allergies:
Medical, dietary, or disability concerns:
2ND GUEST'S FIRST/LAST NAME:
Parent or Child:
Parent
Child
Gender:
Female
Male
Date of Birth:
Care Card (Medical #):
Allergies:
Medical, dietary, or disability concerns:
3RD GUEST'S FIRST/LAST NAME:
Parent or Child:
Parent
Child
Gender:
Female
Male
Date of Birth:
Care Card (Medical #):
Allergies:
Medical, dietary, or disability concerns:
4TH GUEST'S FIRST/LAST NAME:
Parent or Child:
-
Parent
Child
Gender:
-
Male
Female
Date of Birth:
Care Card (Medical #):
Allergies:
Medical, dietary, or disability concerns:
5TH GUEST'S FIRST/LAST NAME:
Parent or Child:
-
Parent
Child
Gender:
-
Male
Female
Date of Birth:
Care Card (Medical #):
Allergies:
Medical, dietary, or disability concerns:
For security purposes, please type out these characters:
Your form didn't submit? Please notify us at info@adventureretreats.ca or 604-302-5758.
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