Youth Orbit Encounter January 18 - Online Registration

Name *

First

Last

Registrant's Email *

Registrant's Phone *

Gender *

Male
Female

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you currently an MCI Student? *

Yes
No

Do you currently live in dorm? *

Yes
No

Add a Hoodie? ($50) *

Yes
No

Size (unisex) *

Health Information

Name on Card *

PHIN (9 digit) *

Family # (6 digit) *

Allergies/Medical concerns (list all)

Addition comments

Church affiliation (if any)

Emergency Contact

Name *

First

Last

Relationship *

Phone *

I am attending Youth Orbit with the consent of my parent/guardian. *

I am attending Youth Orbit with the consent of my parent/guardian. I authorize the staff of Mennonite Collegiate Institute to act for me/my child according to their best judgment in any emergency requiring medical attention, and I waive and release MCI of any and all liability for any injuries or illnesses incurred while at Youth Orbit

Refund Policy *

I understand that until January 9th, I may request a full refund on individual registrations. If extenuating circumstances arise after January 9th, please contact our office. These requests will be handled on a case by case basis.

Photograph Policy *

I grant MCI permission to use any photographs and/or video images of me/my child taken at the event for advertising purposes authorized by MCI.

Electronic Communicatoin Policy *

I agree to receive electronic communications from MCI for the purposes of promotion, or school information that may be of interest. I understand that I can unsubscribe at any time and that my information will not be shared at any time.

Electronic Device Policy *

I understand that all cell phone and electronic device usage is the responsibility of the attendee, and MCI will not actively monitor cell phone use during the event.

Select T-Shirt Size *

(included in the registration cost)

Regular (non MCI student) $50

MCI Student (not dorm) $40

MCI Student (currently in dorm) $25

Group Rate: $40 for groups over 6 people. Contact [email protected]

Total

Price: $50.00

MCI Dorm Student Price

Price: $25.00

MCI Dorm Student Price + Hoodie

Price: $75.00

MCI Student Price + Hoodie

Price: $90.00

Regular Price + Hoodie

Price: $100.00

MCI Student Price

Price: $40.00

Credit Card *

Card

Name on Card

Youth Orbit Encounter January 18 – Online Registration

Health Information

Emergency Contact

Youth Orbit 2023 – Online Registration

Health Information

Parent/Guardian

Request Help with Admissions