Challenger Program Application

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Personal Information

 
Birthdate must be written in DD-MM-YYYY form
 
 
 
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Parent/ Guardian/ Emergency Contact

 
 
 
 
 
 
 
 
Relationship Information

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Education and Work

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Other Background Information

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Medical Information

 
 
 
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Helpful Information

 
 
 
 
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References (Preferably 1 family member, 1 adult who knows you well who is not a family member, and 1 other reference of your choice)

 
 
 
 
 
 
 
 
 
 
 
 
CAYU Program Participation & Driving Waiver

1.  The risk of injury from youth activities and equipment involved in some Youth Unlimited programs is significant, including the potential for permanent disability and death, and although personal discipline will minimize the risk, the risk of serious injury does exist;



2.  I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE of those persons released from liability below, and assume full responsibility for my child/ren's participation;



3. I, for my child/ren, and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Youth Unlimited Central Alberta, the owners and leasers of premises used to conduct the activities and programs, their directors, officers, officials, agents and/or employees ("Releasees"), with respect to any and all injury, disability, death or loss or damage to person or property whether caused by the negligence of the Releasees or otherwise, except that which is the result of gross negligence and/ or wanton misconduct.



4.  I, the undersigned parent/ legal guardian, will not hold CAYU responsible for any personal injury, or care provided, or for any loss or damage whatsoever with respect to my child/ren.  I waive any claim against CAYU, its employees, agents and board members and release them from all liability.  I further indemnify the for all losses they might suffer.



5.  In the event of injury or illness, I authorize CAYU staff to seek and obtain medical or surgical attention for my child/ren named above in the event of an emergency, without the necessity of prior approval.  It is understood that if any emergency occurs, a responsible adult will ensure that my child/ren receives proper medical attention and that arrangements are made for his/ her return home, if necessary.  I understand that I will be notified by the quickest possible means if this authority is exercised.

6. I, the undersigned parent/ legal guardian authorize my child/ child under my guardianship, (named above) to drive with a CAYU staff member or Volunteer who has satisfactorily completed all screening protocol as per CAYU's policies to and/or from any and all activities related to the programming of Central Alberta Youth Unlimited / YFC for which I have authorized permission to attend below.







In signing the release, I (we) understand the intent thereof, and I (we) hereby agree and absolve and hold harmless the Association of Central Alberta Youth For Christ, and any other parties connected with the CAYU programs in any way, singly or collectively from and against any blame and liability for any injury, misadventure, harm , loss, inconvenience or damage hereby suffered or sustained as a result of participation in the event, or any activities associated therewith.  I (we) hereby consent to and permit emergency treatment in the event of injury or illness.  I confirm that the information I have provided is correct.





Under 18 years...
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18 Years and up...
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FOIP Waiver

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Description

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