I , give permission to participate in the BGC group out-trips as outlined below. I understand that these activities involve a degree of risk in varying locations in the lower mainland. Possible out-trips activities include; hiking, water activities, parks and beach activities, activities in public recreation sites such as biking, bowling, laser tag, ropes courses, go-karting, Playland rides, etc. Transportation may include staff vehicles and/or BGC vans.

Guardian's Signature: Date:
Guardian's Address:
Guardian's Phone #:
Youth's Date of Birth: Care Card #:

Please List Allergies (Indicate if it is a serious allergy)

Please List Prescribed Medications

Do you consent to BGC to use photographs, video, etc. for publicity purposes connected with the promotion of the work of BGC? YesNo

Emergency Contact
Name: Phone #:
Relationship: