campers application form 10 by cgz40019

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									                                                                          Application
                                                                            Form
                                                                            2010
     This form should be returned to your Camp Rep. with a deposit of £45 By Sunday 7th February 2010
    Applications can be made at any time up to 14 days before the week of Camp as long as there is space.
                    (Booking Conditions apply—see your Camp Rep. or www.mcyc.co.uk)


Name _________________________________________________ Date of Birth ______________________________________

Address __________________________________________________________________________________________________

Postcode _____________________________        Email Address ______________________________________________________

Tel. No. _________________________________________            (Please only use a mobile no. if it is your main home phone)

Church    _______________________________________________                                   APPLICABLE AGE RANGES

                                                                                         Junior Week - 29 May to 5 June
How would you like your name to appear in the Camp booklet?                         Ages 9 - 11 Born between 1.9.98 & 31.8.2001

______________________________________________________                                       Senior 1 - 17 to 24 July
                                                                                    Ages 18 - 21 Born between 1.9.88 & 31.8.92

   Please note that due to redevelopment it may be necessary                                 Senior 2 - 24 to 31 July
                                                                                    Ages 16 - 17 Born between 1.9.92 & 31.8.94
      to accommodate some girls in tents on the girls field.
                                                                                            Inters 1 - 7 to 14 August
                                                                                    Ages 12 - 15 Born between 1.9.94 & 31.8.98
                 Please tick box to indicate week chosen
 Junior     Senior     Senior      Inters     Inters     Inters       Senior               Inters 2 - 14 to 21 August
 Week         1          2            1          2          3                       Ages 10 - 13 Born between 1.9.96 & 31.8.00
                                                                        +
                                                                                           Inters 3 - 21 to 28 August
                                                                                    Ages 12 - 15 Born between 1.9.94 & 31.8.98

                                                                                      Senior + - 28 August to 4 September
                                                                                    Ages 20 - 30 Born between 1.9.79 & 31.8.90

                         Girls, please state the names of anyone you want to share a chalet with.




                                 PLEASE PRINT THE CAMPER’S NAME IN THIS BOX



                          For Office Use Only
 Junior     Senior     Senior      Inters     Inters     Inters       Senior      The cost of a week of camp in 2010 is £155.
 Week         1          2            1          2          3           +
                                                                                        Provided that the balance of £110
                                                                                       has been paid by 28th March 2010,
                                                                                            you have been accepted
                                                                                             for the week indicated.

                                 Please make cheques payable to “MCYC”



              Camp Reps Signature                                                  Representing (Church or Youth Group)
         EACH SECTION BELOW                                                         THE PARENT OR GUARDIAN
          MUST BE COMPLETED                                                             OF THE APPLICANT
                                                                                            MUST SIGN
 Please delete either YES or NO as applicable and give                             THE FOLLOWING AGREEMENT
 further details if the answer to any of the questions is
 YES. The form will be returned if not completed fully.
                                                                               I agree to my child attending camp and to the
 Does the applicant:                                                           payment of a deposit of £45 which is non-
                                                                               returnable after acceptance. I agree to pay the
 Suffer from any condition requiring regular medical                           balance of £110 not later than 28th March 2010.
 treatment, e.g. Asthma, Diabetes etc.  YES / NO                               I also agree to indemnify the Management Board
                                                                               and its Officers against any additional expense
 ____________________________________________                                  which may be incurred by them in attending to the
                                                                               care and well-being of the applicant.
 Require any medically indicated or vegetarian diet.
 YES / NO
                                                                               In an emergency, caused for example by an
 ____________________________________________                                  accident or illness, it is necessary to obtain
                                                                               parental consent to operative treatment which my
 Is there any reason why he/she should not receive any                         be advised by a medical officer. As delays at
 normal treatments? (e.g. paracetamol, allergic to anti-                       such time are highly undesirable it is required that
 biotics, objection to conventional medicine etc.)                             you give your consent below in case such an
 YES / NO                                                                      emergency should arise.

 ____________________________________________                                  I agree to my child receiving any operative
                                                                               treatment, including the administration of a
 Have any special needs etc, or any other information
                                                                               general anaesthetic or anti-tetanus injection if
 that we will need to know (e.g. particular health
 needs, any mental or physical disability, ADHD etc).
                                                                               recommended by a medical Doctor and give
 YES/NO                                                                        authorisation for an authorised member of camp
                                                                               staff to sign the necessary forms.
 ____________________________________________

 Doctors Name, Address and Telephone Number:

 _________________________________________
                                                                                                Signed (Parent/Guardian)
 _________________________________________
                                                                                   I have read the Campers Agreement below
                                                                                          and I agree to be bound by it.
 _________________________________________

 _________________________________________
                                                                                                    Campers Signature
 Surgery Tel No: ____________________________

                                                         CAMPERS AGREEMENT
1. Each day at camp there will be some time spent looking at the Bible and in praise and worship. You will be expected to attend
   and respect this time and not to disturb other people.
2. No aggressive or offensive behaviour or language will be tolerated.
3. You will be expected to behave with respect at all times; both to each other and to leaders. The Director and the Admin Team
   have the overall responsibility of ensuring MCYC runs smoothly and that everyone is able to enjoy themselves. If they feel your
   behaviour threatens this, you may be sent home.
4. Alcohol, illegal drugs, offensive weapons and tobacco are not permitted at Camp.
5. If you choose to bring a mobile phone and use it inappropriately or at inappropriate times it may be confiscated and
   returned to you at the end of the week.

  You may be photographed at Camp! The photographs may be used for publicity purposes and may appear on related web sites.
                 All Camp Staff are subject to an enhanced disclosure check with the Criminal Records Bureau
             Booking conditions apply and you can get a copy from your Camp rep or download at www.mcyc.co.uk
                   A Facility Of The Tyn-y-Nant Christian Centre. A Company Limited by Guarantee. Registered in England & Wales
                     Company No 4949384 Charity No1102688 Registered Office 13 Village Road, Bebington, Wirral, CH63 8PP

								
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