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 ______________________________________
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
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:
I have read the Campers Agreement below
and I agree to be bound by it.
Surgery Tel No: ____________________________
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