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Soul Survivor

4th - 8th August

 

Section A: Details


Please complete this form for each child.

Mandatory fields are marked with an asterisk (*)
Young Person's First Name(*)
Please provide the Young Person's first name

Middle Name(s)
Please provide the child's middle name(s) if applicable

Surname(*)
Please provide the young person's surname

Male / Female(*)
Please Select Male or Female

School Year(*)
Please select the correct school year.

Date of Birth(*)
/ / Please provide a valid date of birth.

 

Address and Contact Details

House Name or Number(*)
Please provide a valid address

Street Name(*)
Please provide a valid address

Address line 3 (optional)
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Town(*)
Please provide a valid town

Postcode(*)
Please provide a valid postcode

Young Persons Email Address
Please check this is a valid email address.

Young Persons Mobile Number
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Name of Parent / Guardian(s)(*)
Please provide the name of at least one parent or guardian.

Parent / Guardian(s) Email Address(*)
Please provide the the valid email address of a parent or guardian.

Contact Number (1)(*)
Please provide at least two valid contact numbers.

Contact Number (2)(*)
Please provide at least two valid contact numbers.

Contact Number (3)
Please provide at least tow valid contact numbers.

Emergency Contact Name(*)
Please provide an emergency contact name

The emergency contact person would only be contacted in an emergency situation when the parent/guardian cannot be reached

Emergency Contact Number(*)
Please provide an emergency contact telephone number

 

Additional Information

Does your Young Person have any allergies, medical, special educational or dietary needs?
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Is there anything else we may need to know about your Young Person?
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Are you a robot ?
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Section B: Permissions

Photography (Local use)(*)
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I agree to photographs of my child being taken during Soul Survivor and displayed around the church building or in church activities.

Photography (Online)(*)
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I agree to photographs of my child being taken during Soul Survivor and displayed on the Church webpage and/or Social Media

Travel Consent(*)
Please tick this box.

I give Permission for my child to travel by minibus or car with approved leaders.

Medical Consent(*)
Please tick this box.

I give permission for the staff/volunteers participating on the MCC Soul Survivor trip from the 4th - 8th August 2018 to administer any relevant treatment or medication to the young person I am responsible for as the need arises (including paracetamol). Additionally, if a visit to hospital is required, I authorise the staff/volunteers participating at Soul Survivor to take the young person I am responsible for to hospital and give full permission for any treatment required in accordance with the hospital diagnosis. I understand that I shall be notified, as soon as possible, of the hospital visit and any treatment given. I confirm that the medical information supplied to MCC is correct to the best of my knowledge at the time of writing. I will ensure that I inform you in writing of any changes to my child’s health between booking and the actual event.

Data Protection(*)
Please tick this box.

MCC has notified the Data Protection Commissioner of our database as required by the Data Protection Act 1988. The data is kept solely for membership and pastoral purposes and is not disclosed to third parties. If you agree to the information that you have provided being kept on our database please tick this box.

Please sign below(*)
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Section C: Payment


Almost there!

The ticket price is £107 (if booked before 01/05/18) or £117 after that but we need to cover food, travel, accommodation (camping on site) and some equipment hire.

The total cost is £180 unless booked and deposit paid before 30/04/18 when the cost is £170

We have already subsidised this cost but should fundraising go really well we may be able to bring the cost down more.

Please pay £60 deposit per young person (ideally within 48hours of making this booking.)
The remaining balance would be payable by the 30th of June.


If cost is a barrier to your young person attending then please speak to Luke Dale.
Further instructions for how to pay will be included in the confirmation email you will receive shortly after clicking the submit button below.
(*)

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*Earlybird Discounted Price is only valid for reservations made before 30/04/2018.

Cost
£0.00