Kapuskasing Mission Trip Registration

Kapuskasing Mission Trip Registration
Name of trip: Kapuskasing Mission Trip
Location: Kapuskasing, Ontario
When: October 9-12, 2026
What: Help run a family Fall Fair and share Jesus’ love through music and song
Cost: $50 - includes transportation, accommodations and food

For more information, please contact Youth Missions Ontario at missions@adventistyouthontario.org or go to
https://www.adventistyouthontario.org/missions
Name

First NameLast Name
Full Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Phone Number

Area CodePhone Number
E-mail
example@example.com
Please list any allergies that you may have if applicable (food and/or medicinal)
(If Applicable)
Please list any medical conditions that you may have if applicable
(If Applicable)
Dietary restrictions

Other
Gender
Emergency Contact Name & Relation
Emergency Contact Number

Area CodePhone Number
T-Shirt Size
Any special skills?
(If Applicable)
Payment Details
Price Total Field

Mission Trip Registration

$50.00 CAD

Total

Payment Details