October City Teens Weekend

City Teens Booking Form

Booking form for 11th-13th October

Camper Name:

Date of Birth

Age of Camper:

Under 18

18 or over

Gender:

Male

Female

Camper Address:

Address Line 1

Address Line 2

Town/City

County

Post Code

Contact Email

Medical

Name of Family Doctor:

Address of Surgery:

Address Line 1

Address Line 2

Town/City

County

Post Code

Doctor Telephone Number:

National Health Number (if known):

Please give us any information about the camper’s health that would be helpful to know:

Special dietary requirements:

Does the camper have a SPECIAL NEED? This information will help us to plan and maximise their enjoyment of camp:

Emergency Contact Name (1):

Relationship To Camper:

Number For Emergency Contact (1):

Emergency Contact Name (2):

Relationship To Camper:

Number For Emergency Contact (2):

Consent

I understand that in the event of serious illness or accident, every effort will be made to contact me, but if this is not possible, I authorise the Director or any staff appointed by the Director to sign on my behalf, any written form of consent required by medical authorities. I give my consent for the appointed First Aider to administer my child’s medication if required and to deliver medical assistance, including over-the-counter medication if needed.

I agree

I consent to photographs/video being taken during camp for use within BCM, including on the BCM Facebook pages and private Instagram feeds.

I agree

I give permission for my child to attend and take part in the activities or events taking place at Mullartown House. Some of these activities may be off camp property and may include for example: swimming pool, Newcastle shops, beach walk, walk into Annalong, go-karting, outdoor pursuits etc

I agree

I give permission for my child travel in minibuses or cars driven by leaders.

I agree

I understand that the camp is staffed by volunteers and that as part of their duty of care for the campers they must pass on information to statutory bodies if they believe that a camper is in need of additional support, protection or intervention.

I agree

For more information about our Child Protection Policy, click here.

Electronic Signature by Parent/Guardian: (Please type your first and last name which is deemed to be the equivalent of your signature):

Date

Data Protection:

BCM International NI will hold the personal information contained in this online booking form in order to support the camp booking process and to ensure the safeguarding and wellbeing of the named camper.
We will:

Never sell the personal information,
Never share the information with third parties for their own purposes, unless required for statutory obligations,
Have adequate security measures to ensure the personal information is protected,
Make the information available for correction and, if you request, remove the personal information from our database.

We will share the details of this application form with the Camp Directors. Aside from this only administrative staff will have access to your information.

Please pay £40 in cash to the leaders at the bus pick up point on Friday 11th October.

Booking form for 11th-13th October

Medical

Consent

Key Info

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Mullartown House

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