NEWDAY BOOKING FORM 2013
MEDICAL CONSENT, INDEMNITY & DIETARY INFORMATION FORM
Please complete one form for each young person you want to attend Newday. Answer all questions in as much
detail as possible. This form needs to be returned to Lavern Neufville at King’s Church no later than Monday
20th May to ensure you receive the cheaper rate. After this all booking forms should be returned by Monday 22nd
July.
CONTACT DETAILS
Name of young person: ………………………………………………………………………..……………..
Name of Parent/Carer: ……………………………………………………………………………………..
Address: ………………………………………………………………………..………………………………………………………………
Telephone: ……………………………………… Date of birth:
/
/
Current School Year:
Male/Female
Additional emergency contact name and number for 29th July – 4th August 2013: …………………………………………………….
If booked online already, please confirm Booking Reference: NF………./…………
MEDICAL & DIETARY INFORMATION
1) Name and address of GP: ………………………………………………………………………..
2) NHS Number: …………………………………
3) Is your young person currently taking any medication? YES / NO.
If YES, please specify: …………………………………………………………………………………………………...………….…………
4) Does your young person suffer from any allergies (including allergies to medication)? YES / NO
If YES, please specify: ………………………………………………………………………………………………………….………………
5) When did your child last receive a tetanus injection? (Month and year, preferably)
6) Is there anything else about your child’s health you think we should know about? YES / NO
If YES, please specify: …………………………………………………………………………………………………………….…………..
7) Does your child have any special dietary requirements? YES / NO
If YES, please specify: …………………………………………………………………….………………………………….………………..
8) If vegetarian, does your child eat EGGS/CHEESE/FISH?
OUTSTANDING PAYMENTS (Please complete as appropriate)
Please note that all outstanding payments will need to be paid before departure to Newday, unless a payment option has
already been agreed to. Cheques should be made payable to King’s Church.
Data Protection Act 1998: King’s Church will only use personal data in connection with its charitable
purposes. It does not make personal data available to any other organisation or individual.
TRANSPORTATION will be by coach and is being provided by King’s Church. Please clarify below whether or not your
young person requires transportation or if alternative arrangements will be made.
My young person will make their own travel arrangements to get to/from Newday:
If yes, please give specific details of how they will be travelling for each journey.
Yes/No
To Newday:
…………………………………………………………………………………………………..
From Newday:
…………………………………………………………………………………………………..
Parent/guardian name (printed): ………………………………………………………
Signature of parent/guardian: …………………………………………………………
Date: .………/………./………
Newday Tent Sharing/ Consent & Young Person’s Agreement
You will need to provide your own tent or make arrangements for your young person to share with another
young person of the same gender. Please ensure that you have put up any tents and equipment in the
weeks leading up to Newday to make sure that your young person has all the necessary poles, pegs etc.
1. Who is your young person sharing a tent with?
………………………………………………………………………………………………………………
(Tent arrangements must be exclusively male or female)
2. Who does the tent belong to? …………………………………………………………………………………….
3. Tent size excluding guy ropes (NB. we need to know accurate tent dimensions as space on site will be tight):
Please specify dimensions to the nearest metre …….… by ………… and style (i.e. dome or frame) …………..………..
4. How many people will the tent sleep? …………………….
5. Does your young person know how to correctly put up, take down and pack away the tent? (If NO, then we assume they will
need help) YES / NO
Consent & Indemnity
I agree that …………………………………………………………………can take part in all the activities involved during the week,
including going on supervised trips into the local area. My young person clearly understands the behaviour expectations and will
abide by any reasonable instructions given by a youth leader. They have signed the young persons’ agreement which follows. I
understand that in the unlikely event of severe misbehaviour I will need to come and collect them from Newday.
I give my consent for my young person to receive any necessary emergency medical treatment whilst on the above trip and for a
supervising adult (from King’s Church, Catford) to sign any written form of consent required to enable such treatment to be
given, if the delay in obtaining my permission is considered inadvisable by the doctor/hospital concerned. I also acknowledge
and agree that neither the Church nor any of its representatives can be held responsible or liable to compensate for the loss or
damage to any of my child’s personal belongings (including camping equipment) and that my child is responsible at all times for
the safe custody thereof.
I indemnify the Church and its representatives from and against any liability, costs, claims or expenses howsoever arising
whether directly or indirectly as a result of any accident, injury, illness or other damage of any kind whatsoever which my child
may suffer or sustain which is not due to the negligence of any such representative including in particular (but without any
limitation to the generality of the foregoing) where the said accident, injury, illness or other damage is a result of my child
disobeying any lawful, reasonable instructions which may be given to him/her by representatives of King’s Church, Catford.
Signature of parent/guardian: ……………………………………
Date.………/………./………
Young Person’s Agreement
I agree to abide by the following:
a. To attend and participate in all meetings and activities at Newday.
b. To follow instructions as given by the site coordinator, youth leaders or another responsible adult.
c. To register every day in our marquee at the required times and to be in my tent and quiet by the curfew time outlined by the
youth leadership team.
d. To not bring or use any alcohol or illegal substances during the week.
e. To not leave the site without getting the permission of a youth leader.
f. To not go into the tent of anyone of the opposite sex.
I UNDERSTAND THAT NOT FOLLOWING THE ABOVE AGREEMENT COULD RESULT IN MY PARENT/CARER BEING
ASKED TO MAKE ARRANGEMENTS FOR MY EARLY COLLECTION FROM THE SITE.
Signature of young person: …………………………………………………….
Date.………/………./………