D Weekend January 2020

D-Weekend

24th - 26th January 2020

Parental Consent and Booking Form

and payment

Anything written on this form will be held in confidence. The leaders of the D-Weekend need to know these details to meet the specific needs of your minor.

Minor's Full name

Date of Birth

Name by which he/she is known

Sex

Address including post code

Email address of parent or guardian

Phone number (s) of parent or guardian

Medical Details

Details of any known medical conditions such as asthma, diabetes, epilepsy, allergies etc and any medication being taken

Is the minor allergic to any medication? if yes, please specify

When did the minor last have a tetanus injection?

Any weakness or disability calling for special care or attention (including any medicines prescribed, requirements or directions that would be helpful for the leaders to know about

Please provide the name and phone number of his/her primary doctor (if the minor presents health conditions requiring special care or attention they may be contacted)

Does the child have any food allergies? Please name below and we will send you a special dietary requirements form

Emergency Contact

Emergency Contact 1: name, relationship to minor, daytime phone number, mobile number

Emergency Contact 2: name, relationship to minor, daytime phone number, mobile number

Booking details

Group/School the minor is attending with and what year group he/she is in

Faith background (denomination)

Number of Sion events previously attended

Special dietary requirements eg: gluten free, dairy free, celiac, vegetarian

During the time your minor will spend with us, photographs or film may be taken for publicity purposes. Do you agree to your son/daughter to feature in material used for Sion publicity?

Yes No

We would like to keep in contact with you however, we now need your permission to do so. If you would like us to send you news and information, including events, retreats and courses, please tick the boxes below and let us know how you would like to receive the information. We will not share your details with anyone else and you can change your preferences at any time.

Yes I would like to receive news and information from Sion Community I would like to receive this information by email I would like to receive this information by post

I confirm that the above details are correct to the best of my knowledge and that I have read and agree to the terms below.

Name of parent or guardian consenting to the minor attending D-Weekend and completing this form

Payment - please put the amount you are paying in the box below. You will then be taken to another page to make your payment by Credit/Debit card or Paypal

GBP D Weekend Jan 2020

Costs:

The D-Weekend ticket cost is £70 for an individual **

The deposit, which is non-refundable is £20 per person

** Please note: If attending as part of a group or school, the overall price may be affected by transport, insurance and any other costs the group may incure. Please see the trip organiser for the final cost

Terms:

I am willing to allow my minor to attend the D Weekend 2020 at SENT, Sawyers Hall Lane, Brentwood, Essex, CM15 9BX from 24th - 26th January and participate in its activities.

As far as I am aware the above named minor has not been in contact with any infectious disease for the last three weeks and is in good health. In case of any important changes to his/her health, medication or needs and also of any changes to our address or to any of the phone numbers given, I will inform the D weekend leaders.

In the event of illness or injury of the above named minor, I authorise for first aid – if available – to be administered where considered necessary by a trained first aider, and for medical treatment to be administered by a suitably qualified medical practitioner.

If I cannot be contacted and the above named minor should require emergency hospital treatment, I authorise the person designated by Sion Community to sign on my behalf any written form of consent required by the medical authorities provided the delay required to obtain my own signature might be considered likely, in the opinion of the doctor or surgeon concerned, to endanger my minor’s health or safety.

In the absence of any breach of duty by D-Weekend Organizers, participation in D-Weekend is entirely at the participant’s own risk. I understand that D Weekend does not accept liability for any medical bills; at all times this remains the responsibility of the parents/guardians.

I understand that my son/daughter’s participation in the D-Weekend can be terminated if he or she is found to have participated in any gross misconduct, which is prejudicial to the good running of the camp or to the reputation of the D-Weekend. If participation is terminated, I will arrange for immediate travel home.