Personal Information

First Name Last Name

E-mail

Birthday

Grade in Fall

sex male female

T-shirt size
XS S M L XL XXL

Current Address

City

Province Select Province or TerritoryAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Postal Code

phone # cell #

Contact Information

Medical Information

Health Care #

Please list any allergies or food allergies that you have.


Please list any medication that you will be bringing with you and reasons for taking them.

Medical History that we should be aware of?

Church Info

Current Church

Church Attendance
regularily attend occasionally attend seldom attend

Dates,Practicum, and Out-Trips

LTD week this year is July 3-9.

Level 2

The Level 2 hiking trip is tentatively shceduled for July 25-30 or Aug 8-13.  Please select which week you prefer.  Space is limited so it is first come firt served.  

Out-trip Choice Out-trip A (July 25-30) Out-trip B (Aug. 8-13) no preference  

Level 3

The Level 3 out trip is going to the Mustard Seed in Edmonton for their Student Urban Placement program.  The dates for that trip are July 18-23. 

During Level 2 and 3 you are required to do 1-2 practicums per summer. There is also a possibility of participating in additional Practicum weeks.

For this section, indicate how many weeks you would like serve and then indicate which weeks you are available to be at camp and which type of practicum (jr.cabin leading, service, or program) you would prefer. Upon re-acceptance into the LTD program, we will indicate which weeks you have been scheduled for.

I would like to do:
1 week 2 weeks 3 weeks 4 weeks

The Program

 

Your Past Year

 

 

How are things with you and your mentor?


How have you been involved in your church over the past year? What have you learned from it?


How would you change the LTD program if you could? Is there a session topic that you would like to see at LTD week this year?


Any other thoughts or comments?

Parent or Guardian Release - please read carefully

Gull Lake Baptist Camp conducts camps for children and adults on a yearly basis. Every precaution is made to ensure the safety and well being of each camper. Even with normal camp activities such as outdoor games and contact sports there are certain risks involved. I understand and accept these potential risks and, by my signature below, am bound to release forever Gull Lake Baptist Camp, and all individuals associated with it, from any and all liability for injury or damage which may be sustained by the undersigned, or property of the same at or in transit to or from any camp conducted activity, or under the auspices of Gull Lake Baptist Camp. In the case of emergency, I give permission for Gull Lake Baptist Camp & the physician selected by the camp to utilize local ambulance/EMT services, hospitalize, secure proper treatment for, and order injection or surgery as deemed necessary for the health and well being of my child or person named on the first page of this registration form. I also give Gull Lake permission to administer any required over-the-counter medications and/or medications prescribed to my child by their physician.

As best as I can, I will support Gull Lake in the LTD program’s goals to help my child grow as a follower of Christ, to become more like Him in the way He leads and serves others. I have read and understood the above release.

Parent/Guardian name

LTD consent

I understand my responsibility to participate in all aspects of the program including the training week on-site, the out trip, summer and winter practicums, and fall retreat. I am willing to pay the registration fee of $650 upon my re-acceptance into the program, at the latest, by June 1, 2010.

LTD Name

Make sure that you have filled in all of the necessary information. When you are sure that you have completely filled in the information press the SUBMIT button below