Under-18 Declaration

Please complete the following details as fully as possible.

1. Personal Details of Delegate

Name :                       __________________________________________________________

Address :                     _______________________________________

_______________________________________

_______________________________________

Postcode                     _________________

Telephone :                 _________________

Email address :              ____________________________________

Date of birth :              ______________   Age at Conference:  _____ years _____ months

Ecclesia/Youth Circle      ______________

2. Medical Information

Please note any allergies, medical problems, medicines being taken, and any other information we should know about.

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Vegetarian ?     Yes / no

Family doctor :            Name               ___________________________

Telephone       ___________________________

  Please Turn Over

Declaration and Consent for Under 18s to be signed by parent/guardian

1. Activities

I understand that Delegates at the Hoddesdon Christadelphian Conference will be involved in a range of activities, including attendance at workshops, and other general activities at the High Leigh Conference Centre.  I understand that whilst all activities will be supervised by the Committee, the Tutors and Session Leaders, delegates will be expected to behave in a careful and responsible manner at all times. Some photos and video may possibly be used in promotional activities and on our website, and I give permission for these to be taken and used.

2. Medical attentionIn the event of an illness/accident which requires emergency hospital or dental treatment and I cannot be reached or should the delay to obtain my signature be considered inadvisable by the doctor/surgeon/dentist, I, the undersigned, give my permission for my child to be treated by a licensed physician, and for the said physician to administer whatever care is necessary, including anaesthesia, for his/her safety and care.

3. Emergency contact details during Hoddesdon

NAME ___________________________________________________________________

ADDRESS (please state if you will be at Hoddesdon yourself)

___________________________________________________________________

Telephone       : _____________________

Signature of Parent/Legal Guardian

___________________________________________________________________

Name __________________________________________________________________

Date    _____________________

 Download a printable form here.