ND23

Emmanuel @ Newday 2023

For more info, head over here: https://www.weareemmanuel.com/newday
Your Email Address*
For contacting you with any important information
Your Mobile Number*
For contacting you with any important information
Delegate Details
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Gender*
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Youth Group*

Emmanuel 15-18sEmmanuel 11-14s Clarendon CentreEmmanuel 11-14s WestYouth LeaderCatering TeamLiberty ChurchEmmanuel Belfast

Parent / Carer Details
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityCounty

Postcode

Medical Information
Name of Doctor's Surgery*
Doctor's Surgery Phone Number*
Please enter a valid phone number.
Doctor's Surgery Address*

Street Address

Street Address Line 2

CityCounty

Postcode
NHS Number*
Dietary Requirements (Tick As Appropriate)*

No Dietary RequirementsVegetarianVeganGluten FreeDiabeticDairy FreeNut IntoleranceOther
Other requirements e.g. mobility, sensory
Details of known allergies/sensitivities (e.g. penicillin)*
If none, please enter None
Details of medicines currently taking*
If none, please enter None

Emergency Contact
Name*

First NameLast Name
Relationship to Delegate*
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Permission
1. I give permission for the delegate to attend and take part in the event named.

2. In the event of the delegate needing medical attention, I give consent for the
Leaders to take whatever action they deem necessary for his/her benefit.

3. I give permission for the delegate to leave the showground with Youth Leaders.

4. I am happy for the delegate to be given Paracetamol if necessary.
Permission Agreement*

I agree to the above
Photography and Filming
We often take photos and/or videos of our young people at the event. If you'd rather us not feature (e.g. a close up shot of them with some friends) your young person in our media, please let us know below.

Unfortunately, we can't guarantee that they won't be picked up in any Newday filming (e.g. in the background of an interview, a shot of young people in the big top or people hanging out at a cafe) but we'll ensure all our team are aware that you don't want them to be featured in interviews etc.

If you ask for them not to be featured, could we also ask that you speak with your young person too? It can be tricky as we aren't always with them and the Newday media team are often interviewing young people.
Photography*

I am happy for the delegate to be photographed and filmed during the event, to be used for Newday and Emmanuel promotions.Please avoid featuring the delegate in any photos or videos during the event (see above)
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Emmanuel @ Newday 2023

Delegate Details

Parent / Carer Details

Medical Information

Emergency Contact

Permission

Photography and Filming