UNDER 18s CONSENT FORM
BOLD YOUTH CONFERENCE - 8TH-10TH NOVEMBER 2024
DETAILS OF DELEGATE
If The Delegate Is Under 18 This Section Is To Be Completed By Parent/Carer
Name of Person Attending The Conference
*
First Name
Last Name
Prefers To Be Known As
(Optional)
Address
*
Post Code
*
Back
Next
DETAILS OF DELEGATE
If The Delegate Is Under 18 This Section Is To Be Completed By Parent/Carer
Sex
*
Male
Female
Date of Birth
*
/
Day
/
Month
Year
Date
Church Group
*
Back
Next
EMERGENCY CONTACT DETAILS
Adult Emergency Contact Name
*
Contact Number
*
Please enter a valid phone number
Family Doctor
*
Back
Next
MEDICAL DETAILS AND MEDICATION
If None Click 'Next'
Please tell us below if there are any medical conditions we need to aware of
Please tell us below of any medication required. Please also tell us here if the medication requires refrigeration
PLEASE NOTE: WE ARE UNABLE TO TAKE RESPONSIBILITY FOR MANAGING YOUR CHILD'S MEDICATION. SHOULD YOUR CHILD NEED SUPERVISION OR REMINDING PLEASE SPEAK TO YOUR YOUTH LEADER.
*
PLEASE TICK HERE TO ACKNOWLEDGE YOU HAVE READ AND UNDERSTAND THIS
Back
Next
DIETARY REQUIREMENTS
If None Click 'Next'
Please give details of any special dietary needs we should be aware of (e.g. food allergies):
Back
Next
PARENT/CARER PERMISSIONS
We may take photos and videos of activities for publicity purposes over the course of the weekend. Before taking images of children under the age of 16, we need parent/guardian permission. May we use images of your child for publicity purposes in brochures, press releases, on social media or on our website?
*
YES
NO
I agree to my son/daughter attending and participating in the BOLD Youth Conference, and the activities run by the team. I understand that every care will be taken to ensure the health, safety and welfare of my child. I realise and accept that in the event of my child's behaviour adversely affecting the safety of the activity, the organisers reserve the right to return my child home.
*
PLEASE TICK HERE TO ACKNOWLEDGE YOU HAVE READ AND AGREE
If my child becomes ill or has an accident that requires emergency treatment, I authorise all medical and surgical treatment, X-ray, laboratory, anaesthesia and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/carer can be reached in the case of an emergency.
*
PLEASE TICK HERE TO ACKNOWLEDGE YOU HAVE READ AND AGREE
SIGNED
*
PRINT FULL NAME
*
PARENT/CARER
Contact Email
*
example@example.com
Submit
Should be Empty: