welsh seventh-day adventist youth

Three Missions Easter Weekend

Application form

Please make sure that all the details you fill out in this form relate to the person who will be attending the event.

Section 1: Personal details

Name*

First

Last

Gender*

Date of birth*Use the calendar or enter the date using the format shown.

dd/mm/yyyy

Address*

Address 1

Address 2

City

State

Postal Code

Country

Home Number*If you do not have a home number, please write "none"

Mobile*If you do not have a mobile number, please write "none"

Email*

Are you in good health?*If NO, please continue to fill-in this section and if you need to add further details use the box at the end of this section.

Yes

No

Have you ever experienced any of the following health conditions?*If YES, please tick those that apply, and give further details below.

Diabetes

Heart problems

Travel sickness

Kidney disease

Fainting spells

Menstrual problems

Bed-wetting

Mental health problems

Epilepsy

Hayfever

None of the above

Have you ever been hospitalised with any of the above health conditions, or any other condition not stated above?*If YES, give further details. If NO, write NO.

Have you ever had or do you currently have asthma?*

Yes

No

Do you carry an inhaler or any other medication for your asthma?*

Have you ever been hospitalised due to your asthma?

How many times have you needed to use your blue inhaler in the past 2 weeks?*

Have you received vaccination against tetanus in the last 5 years?

Are you allergic to any of the following?

Penicillin

Anaesthetic

Plasters

Nuts

None of the above

Do you have any other allergies (e.g. to foods or medicines?)*If YES please give details. If NO, please write NO

Are there any other medical conditions/issues that we need to be aware of? **If YES, please give further details. If NO, please write NO.

Are you currently taking any prescriptions medications?*If YES, please write YES and give details re: dosage, specific storage requirements etc. If NO, write NO.

Do you have any behavioural challenges that we need to be aware of?*If YES, please write YES and give details. If NO, write NO.

Do you have any special dietary requirements?*All meals will be vegetarian. If you do have dietary requirements please write YES, and give details. If NO, please write NO. Please note that we can only provide alternative food/meals based on requirement, not preference.

Do you have any disabilities that we need to be aware of?*

Section 3: Emergency Contact Details

Please make sure that all the details you give in this section relate to the parent(s) / legal guardian(s) of the person detailed in Section 1.

In the unlikely event of an emergency, please tell us who you want us to contact:*

First

Last

Relationship of above person to you:*

Home phone number*Write "none" if the person doesn't have a home phone

Mobile phone number*Write "none" if the person doesn't have a mobile phone

Work phone numberIf they have one

Your G.P.'s name*

Your G.P.'s telephone number*

G.P.'s address:*

Section 4: Consent for activities

This section should be filled out by the parent(s) / legal guardian(s) of the person detailed in section 1. Please complete this section in full. Please read the following statements carefully. If you do not indicate your agreement to all of them, the attendee may need to be excluded from some events.

Current regulations relating to child protection issues and taking photographs of young people require that we obtain your consent for any picture taken which is used in video, on the web, or in printed publication if the person is under 18 years of age. Please indicate your consent by selecting "yes", even if you are over 18.*If you indicate "no" your child may be excluded from some activities

The event organisers will be providing transport from Hebron Hall for excursions in the area. If you are under 18 we are required to obtain your permission beforehand. This transport will be either in a minibus/car/coach or other roadworthy vehicle, and all drivers will hold a current driving license relevant to the category of vehicle they are driving. Please indicate your consent by selecting "yes" even if you are 18 years or above.*If you indicate "no" your child may be excluded from some activites.

Swimming: There is a swimming pool at Hebron Hall. If the pool is used we will take the appropriate safety measures. Please answer the following questions:

Are you/is your child able to swim 10m?*

Are you/is your child water confident in a pool?*

Are you/is your child safety conscious in water?*

Please indicate your consent for your child to take part in water activities.

If you as a parent/guardian of a child who is under 18 and you would not like your child to take part in certain activities, please give details below:

Section 5: Code of Conduct by Camper

This is a Christian Retreat, organised and run by the Seventh-day Adventist Church. As such, principles of Christian behaviour form the foundation of how to relate to each other and to God. The following is expected of each person who attends the Retreat as well as each member of staff:

a) RESPECT: be respectful of yourself, others & God
b) APPEARANCE: dress appropriately for the task & occasion
c) SAFETY: listen to, and do what the leaders ask

Smoking, alcohol, drugs, knives or any other item which could be harmful to oneself or others are banned from the Retreat. Possession or use of any of these items by the attendee could result in the person(s) involved being asked to leave the Retreat immediately. Any costs incurred by the organisers will be passed onto the person (if they are 18 or over) or their parents / legal guardians (if under 18).

Please indicate your agreement with the above by clicking "Yes".*If you do not agree to the above, please do not apply to attend this Camp.

Yes

Males and females will stay in separate rooms unless they are a married couples. We ask that no-one goes into a room belonging to someone of the opposite gender. Please indicate your agreement to this by selecting "Yes".*If you do not agree with this, please do not apply to attend this Camp

Yes

As this is a Christian Retreat, we have regular worship times. These worships are mandatory for everyone. Please indicate that you accept this below: *If you select "I do not agree", your application form Camp will be rejected.

Policy on mobile phones: mobiles should not be used inappropriately during worships nor to play music or watch videos. Inappropriate use of mobiles will lead to the mobile being confiscated if necessary.*If you do not agree to this, your camp application may be rejected.

Section 6 - Committment

This section should be completed by the parent / legal guardian of the person described in Section ONE if the person attending the event will be under 18 years of age. All statements below refer to the person described in Section ONE. Please read each statement carefully.

Committment - to be filled in by parents of children who are under 18.*

For parents of under 18's - This application form is correct as far as I know and the person described in Section ONE has permission to engage in all activities, except as noted by me. I consider them fit to participate in this youth event and acknowledge the need for obedience and responsible behaviour on their part. If any of the above circumstances / details change before the commencement of the Retreat, I will make it my responsibility to immediately inform the Retreat Co-ordinator of the change, in writing (either by post or by email).

I am 18 years old or above and if any of the above circumstances / details change before the commencement of the Retreat, I will make it my responsibility to immediately inform the Retreat Co-ordinator of the change, in writing (either by post or by email).

Medical Treatment*

For parents of under 18's - I agree to my the person described in Section ONE receiving medication as instructed by me on this form and any urgent dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present.

I am 18 years old or above and I agree to receive urgent dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present, if necessary.

I do not want (the person described in Section ONE) to receive medical treatment under any circumstances.

Fees

By submitting this form online I agree to pay the Retreat fee in full. In the event that the person described in Section ONE cannot attend the Camp after this application form has been processed, I understand that I cannot be guaranteed a full refund.

Cost for the weekend: £75

This is for those coming from Wales and/or with their own transport to Hebron Hall Christian Centre.

Payment: Please send full payment, along with your application form by Friday March 19th. Cheques payable to Welsh Mission Youth. Applications sent after this date may incur a late application fee and as places are limited we cannot guarantee a place.

Send to: Jeremy Tremeer, 14 Cenydd Terrace, Senghenydd, Caerphilly, CF83 4HL.

Telephone: 02920 832559

Mobile: 07956 627233

email: jtremeer@adventistwales.org

Further retreat information.*Please indicate how you would like to receive further info about the Camp by selecting only 1 option from below:

I would like to receive the info by email

I would like to receive the info through the post

I will check online regularly for further information

Welsh Adventist Youth

Three Mission Easter Weekend Application Form