Registration Form

CHURCHES TOGETHER IN BASILDON – PROJECT 58:7 SPONSORED SLEEP-OUT

REGISTRATION & UNDER 18s PARENTAL CONSENT FORM

Friday 2ndSaturday 3rd December 2016 10pm – 7.30am inc. breakfast

In the grounds of Trinity Methodist Church, Clay Hill Rd/Bardfield, Basildon SS16 4NN

WE NEED YOUR SUPPORT FOR THE 8TH SLEEP-OUT IN BASILDON TO HELP THOSE IN NEED

Please complete this Registration Form and, if applicable, the under 18s Parental Consent Form to hand in at the Church on the night

**NB You must not participate against medical advice or if you are not in good health**

 YOUR NAME (caps)

 

 

 ADDRESS (Caps)

 (if applicable)

 

 

 EMAIL ADDRESS FOR FUTURE

 CONTACT RE. SLEEP-OUT

 

 

 NAME OF YOUR CHURCH

 (if applicable)

 

 

 YOUR TEL NO.

 

 

 TEL NO. FOR NEXT OF KIN,

 PARENT OR GUARDIAN FOR

 EMERGENCY CONTACT ONLY

 

 

 

 

 RELATIONSHIP TO YOU

 

 ANY SPONSORSHIP MONEY

 PROMISED? IF SO, HOW MUCH

 APPROX?

 

 When all money collect in, we will need your sponsorship

  Form with full address & postcode of Gift Aid donors,

   in order to process the claim

 

 PLEASE CIRCLE WHICH APPLIES

  

            18 OR OVER                          UNDER 18

 

 MEDICAL CONDITIONS OR  NEEDS

 

 FOR UNDER 18s, TREATMENT

 REQ’D & KNOWN ALLERGIES

 

 

PARENT/GUARDIAN:    I give my permission for my son/daughter to attend the sponsored Sleep-out to be held at Trinity Methodist Church, Clay Hill Rd/Bardfield, Basildon.  I undertake to inform the Sleep-out Committee if the young person named above or any member of their family, or other person with whom they have close contact, is known to have or contracts any infectious disease.

If, during the course of the Sleep-out, it becomes necessary for the young person named above to receive emergency medical treatment, including the use of anaesthetics, and I cannot be contacted, I authorize (please PRINT NAME clearly)……………………………………….....…...........................................`to sign the documentation required by the medical authorities.

Signature of Parent/Guardian: ………………………………………………………….

NAME (please print) ………………………………………………………