SOAK and BreckFest Youth Radio will run from Wednesday 11th to Friday 13th April 2018. SOAK will meet at Trinity Methodist Dereham at half 10 each day and finish at 3pm. Breckfest Youth Radio will be on air from 7am on 11th April till 9pm on Friday 13th.
A completed registration form is required for each young person participating in SOAK and BreckFest Youth Radio . If you have any problems completing the form, please contact Paul on 07747 471221. Completed forms will be returned to the parent named below at the address you provide. A signed slip will need to be posted to North Breckland Youth for Christ c/o Church House, Church Street Dereham NR19 1DN or handed in at SOAK. This is for school year 6 upwards.
I would like to sign up for... *
Name and D.O.B
Forename *
The first name of the young person this form relates to.
Your answer
Surname *
The last name of the young person this form relates to.
Your answer
Gender *
Date of birth *
MM
/
DD
/
YYYY
Contact Information of Parent/Guardian
Parent/Guardian's Contact details are required in this section
Parent/Guardian's mobile number
We would like to stay in touch. Please see our 'data protection policy' to learn more about how we'll keep your number safe and use your info.
Your answer
Parent/Guardian's email address
We would like to stay in touch. Please see our 'data protection policy' to learn more about how we'll keep your number safe and use your info.
Your answer
Contact Information of Young Person
Main address of Young Person this form relates to (Please include post-code) *
This is the address you live at most of the time. If you live at more than one address, please enter this in the 'Alternative Address' section below.
Your answer
Alternative address (Please include post-code)
Complete this if you live at more than one address.
Your answer
Emergency Contact Information & Dietary Requirements
Dietary and medical information *
Please let us know any relevant information which may be helpful for catering or in case of emergency during your stay. We need this each time, in case anything has changed since you last told us. If nothing, then just put 'none' in the box.
Your answer
Your Doctors name and contact details *
Include the name of the surgery and a phone number.
Your answer
Primary emergency contact name *
Give the first and surname of young person's primary emergency contact (this may be a parent/guardian).
Your answer
Primary emergency person contact details *
Provide contact information for young person's primary emergency contact. This needs to be a phone number. Preferably a land line and a mobile. You can also include email details.
Your answer
Primary emergency contact relationship to you *
e.g. mother, family friend etc.
Your answer
Secondary emergency contact name *
Give the first and surname of young person's secondary emergency contact.
Your answer
Secondary emergency person details *
Provide contact information for young person's secondary emergency contact. This needs to be a phone number. Preferably a land line and a mobile. You can also include email details.
Your answer
Secondary emergency contact relationship to you *
e.g. mother, family friend etc.
Your answer
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