Blaze Youth Weekend Away 1st - 3rd May 2026 Registration & Consent Form
Youth Full Name
*
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date
School Year
Please Select
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Year 13
Gender
Please Select
Male
Female
Other
Parent / Guardian Contact Details
Name
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: 000 0000 0000.
Relationship to Youth:
Additional Emergency Contact : (Different from above and only used in case parent listed is not contactable)
First Name
Last Name
Additional Emergency Contact Mobile Number
Please enter a valid phone number.
Format: 000 0000 0000.
Relationship to Youth:
Dietary Requirements :
Please give details of any disabilities, allergies or medical conditions of which we should be aware of:
Please give any details of any medication currently taken (including the dosage and whether self-administered):
Permissions
To be read and signed only by a parent or other adult with parental responsibility
I give permission for my son/daughter to take part in the Youth Weekend Away.
*
Yes
No
I understand that the leaders organising the Youth Weekend Away will take all reasonable care in looking after my son/daughter but they cannot necessarily be held responsible for any loss or damage to property during, or as a result of the weekend.
Yes
No
I give permission for my son/daughter to be given basic medical attention, such as paracetamol or plaster for minor injuries or sickness. This will be administered by the named first aider.
Yes
No
In an emergency, if I cannot be contacted despite all reasonable attempts to do so by the leaders I give permission for my son/daughter to undergo emergency medical/dental treatment, including the use of anaesthetics, as considered necessary by the medical authorities.
Yes
No
I give photo permission of my son/daughter at the youth weekend away (photos will not be used for any publicity outside of the church).
Yes
No
I give permission for leaders at the weekend away to share photo/video updates throughout the weekend which could include my son/daughter on the Youth Parents WhatsApp group.
Yes
No
We want the youth to have minimal distractions at the weekend away therefore we will ask all youth to turn off their phones and they will be handed in to be locked in a box. I understand that my child will be asked to turn off their phone for the duration of the weekend and handed in, if contact needs to be made home this will be done so by a youth leader directly.
Yes
No
If there is any other information you need to make us aware of or would like to speak further with a youth leader please let us know below:
Signature
Submit
Should be Empty: