Please fill in and submit the below form before the Youth Weekend.

By submitting below I am acknowledging:

I give permission for my child to participate fully in all activities over the Youth Alpha weekend.                                                         

I understand and agree to Ben Webb being in loco parentis of my child/children for; the weekend of the 19th October 2018 7:30pm to 21st October 2018 at 1:00pm or for the duration of the weekend, in which, they are present.

In an emergency, I am willing for my child to receive necessary treatment and be given medication.

I am willing to be contacted at any time during this event in an emergency.

Young Person's Name *
Young Person's Name
Date of Birth *
Date of Birth
My son/daughter cannot eat:
Please give the reaction caused by eating the foods listed above if applicable