BOLD 2024 Registration Form

PLEASE ENTER YOUR EMAIL ADDRESS TO BEGIN
Email Address*
example@example.co.uk
The information given on this form is solely for the use of the youth leaders at BOLD Conference and is not available to any other individuals or groups. This means that we will not disclose your e-mail address, mobile number, or any other details to another individual without your permission.

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 NameLast Name
Prefers To Be Known As
(Optional)
Address*
Post Code*

DETAILS OF DELEGATE

If The Delegate Is Under 18 This Section Is To Be Completed By Parent/Carer
MaleFemale
Date of Birth*

DayMonthYear
Date
Church Group*

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):

Parent/Carer of a Young Person Aged 11-17A Young Person Aged 18+
PLEASE NOTE: IF DELEGATE IS UNDER 18 YEARS OF AGE THIS MUST BE COMPLETED BY THEIR PARENT/CARER

PARENT/CARER PERMISSIONS
YESNO
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

Please select below*

BOLD CONFERENCE 2025

FULL WEEKEND TICKET - EARLY BIRD RATE

£125.00

BOLD CONFERENCE 2025

DEPOSIT ONLY

£30.00

Enter coupon

Total

£0.00

PLEASE ENTER YOUR EMAIL ADDRESS TO BEGIN