BOLD 2024 Self Declaration Form - Over 18s

BOLD 2024 Self Declaration Form - Over 18s

SELF DECLARATION FORM

BOLD YOUTH CONFERENCE - 3RD-5TH OCTOBER 2025
DETAILS OF DELEGATE
Name of Person Attending The Conference*

First NameLast Name
Prefers To Be Known As
(Optional)
Address*
Post Code*
Email*
example@example.com

DETAILS OF DELEGATE
MaleFemale
Date of Birth*

DayMonthYear
Date
Church Group*

EMERGENCY CONTACT DETAILS
Adult Emergency Contact Name*
Contact Number*
Please enter a valid phone number
Family Doctor*

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 TICK HERE TO ACKNOWLEDGE YOU HAVE READ AND UNDERSTAND THIS

DIETARY REQUIREMENTS

If None Click 'Next'
Please give details of any special dietary needs we should be aware of (e.g. food allergies):