Please complete the following details as fully as possible.
1. Personal Details of Delegate
Name : __________________________________________________________
Address : _______________________________________
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 ___________________________
Please Turn Over
Declaration and Consent for Under 18s to be signed by parent/guardian
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
ADDRESS (please state if you will be at Hoddesdon yourself)
Telephone : _____________________
Signature of Parent/Legal Guardian
Download a printable form here.