Camp Belvoir Waiting List

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REGISTRATION FOR CAMP BELVOIR IS NOW CLOSED.

If you would like to join the waiting/reserve list please complete the form below

Child's Details

Child's Name *

Child's Date of Birth *

YYYY

Child's Age during Camp Belvoir

Parent/Carer Details

Name of Emergency Contact

In the event of an emergency we will contact this person

Phone number of Emergency Contact *

Email Address *

Alternative Emergency Contact *

Alternative Emergency Contact Number *

Special Requirements

Details of any known conditions, allergies etc (nuts, asthma, diabetes...) and any medication being taken

Any other needs

Consent

In the event of illness or accident, having parental responsibility and care of the above named child, I give my permission for medical treatment to be administered when necessary. If I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital. However I understand that every effort will be made to contact me as soon as possible. I confirm that the above details are correct to the best of my knowledge. By signing this form I also give permission for photographs or videos to be taken of my child and used for church purposes on the church website or church Facebook page. If you would rather your child was not included in photos and videos please contact Catherine at catherine@belvoirparish.co.uk

Signed *

Date *

YYYY

Submit

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