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Youth Weekend Away 2018

Section A: Details


Please complete this form for each child.

Mandatory fields are marked with an asterisk (*)
Young Person's First Name(*)
Please provide the Young Person's first name

Middle Name(s)
Please provide the child's middle name(s) if applicable

Surname(*)
Please provide the young person's surname

Male / Female(*)
Please Select Male or Female

School Year(*)
Please select the correct school year.

Date of Birth(*)
/ / Please provide a valid date of birth.

 

Address and Contact Details

House Name or Number(*)
Please provide a valid address

Street Name(*)
Please provide a valid address

Address line 3 (optional)
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Town(*)
Please provide a valid town

Postcode(*)
Please provide a valid postcode

Young Persons Email Address
Please check this is a valid email address.

Name of Parent / Guardian(s)(*)
Please provide the name of at least one parent or guardian.

Parent / Guardian(s) Email Address(*)
Please provide the the valid email address of a parent or guardian.

Contact Number (1)(*)
Please provide at least one valid contact number.

Contact Number (2)(*)
Please provide at second valid contact number.

Alternative Emergency Contact Number(*)
Please provide at least one valid contact number.

(in case a parent cannot be contacted)

 

Additional Information

Does your Young Person have any allergies, medical or special educational needs?
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Is there anything else we may need to know about your Young Person?
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Section B: Accommodation


At Knock, campers will be accommodated in small rooms on single gender corridors. Please write down the names of up to the three other young people you (or your young person) would like to be roomed with. While we cannot offer any guarantees, we will endeavour to meet these requests. If you have no preference, please leave blank.

Camper 1

Camper 2

Camper 3

 

Section C: Permissions

Photography (Local use)(*)
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I agree to photographs of my child being taken during the Weekend Away and displayed around the church building or in church activities.

Photography (Online)(*)
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I agree to photographs of my child being taken during the Weekend Away and displayed on the Church webpage and/or Social Media

Travel Consent(*)
Please tick this box.

I give Permission for my child to travel by minibus or car with approved leaders.

Medical Consent(*)
Please tick this box.

I give permission for the staff/volunteers participating on the MCC Youth Weekend Away activities from the 16th - 18th March 2018 to administer any relevant treatment or medication to the young person I am responsible for as the need arises. I give permission for the young person in my care to be given a dose of paracetamol (appropriate for their age) as a once off should they ask for it and have a minor complaint which the first aider feels this would help with (for example a headache). Should further doses be required or if the first aider deems the problem to be any more serious we would of course be in contact. Additionally, if a visit to hospital is required, I authorise the staff/volunteers participating on the YWA 2018 to take the young person I am responsible for to hospital and give full permission for any treatment required in accordance with the hospital diagnosis. I understand that I shall be notified, as soon as possible, of the hospital visit and any treatment given. I confirm that the medical information supplied to MCC is correct to the best of my knowledge at the time of writing.

Data Protection(*)
Please tick this box.

MCC has notified the Data Protection Commissioner of our database as required by the Data Protection Act 1988. The data is kept solely for membership and pastoral purposes and is not disclosed to third parties. If you agree to the information that you have provided being kept on our database please tick this box.

Please sign below(*)
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Are you a robot ?
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One Young Person attending YWA 2018

£50.00

Section D: Payment


Almost there!

The cost for the Youth Weekend Away 2018 is £50.

Payment in full is required on or before 18/02/2018.

Total to Pay
£0.00

Further instructions for how to pay will be included in the confirmation email you will receive shortly after clicking the submit button below.