Diocese of Charlottetown   ~  Office of Youth Ministry
"So You Think You Can Lead?"
Youth Leadership Weekend
February 5th - 6th, 2010
Marguerite Bougeoys Centre in Summerside

REGISTRATION

Name: ___________________________________________________________

Address: _________________________________________________________

Phone: __________________   E-Mail: __________________________________

Date of Birth: ________________  Parish: ________________________________

Special Needs: _____________________________________________________

Ministry Interests: ____________________________________________________

Please note:

1.  Copy this form for additional registrations.

2.  The cost for the weekend, including meals and accommodations, is $95/person.  Please make checks payable to:  Diocese of Charlottetown.

3.  If you require additional information, please call Diocesan Coordinator, Susan Nye-Brothers, at 583-2510 or 969-4982.

4.  Please return all completed applications to your youth minister, pastor, or pastoral associate.  You may also mail or fax your completed application to:

Youth Leadership Weekend, c/o Diocese of Charlottetown
Attn:  Susan Nye-Brothers
P.O. Box  907
Charlottetown, PE  C1A 7L9

Fax:  902-892-1253

Waiver and Release for participants under 18 years of age.

I/We give consent and approval to the registrant named above to participate in all workshop/retreat activities.  Furthermore, I/We agree to waive, release and forever hold harmless the Roman Catholic Episcopal Corporation and its employees and volunteers from all claims for damages occurring from accident or injury to person or loss of property through the registrant's participation in the workshop/retreat.

______________________________                  ______________________________

Signature of Parent/Guardian                                   Emergency Contact Number

This application must be signed by the Parent/Guardian of any registrants under 18 years of age.