Energize Activity Weekend
15-17 February 2019, PGL Caythorpe.

We are pleased to offer 40 spaces to young people living in the Birchwood, Moorland, Monks Road, Ermine or St Giles areas of Lincoln. Spaces are limited so we will allocate on a first come, first served basis.

If you have any questions about the weekend, please contact luke@actstrust.org.uk, or call the office on 01522 542 166.

Email address *
Personal Details
Name of Child (please give all names of children you wish to sign up to the weekend) *
Your answer
Age (please be aware the weekend is aimed at young people aged 11 and older). If you are signing up more than one child, please list all their ages. *
Your answer
Parent/ Guardian name *
Your answer
I confirm that I am over 18 and legally responsible for all children I am signing up to the weekend. *
Relationship to child *
Your answer
Contact number *
Your answer
Address *
Your answer
Postcode *
Your answer
I can confirm I live in (or within close proximity to) a CIN fundable Neighborhood: Sincil Bank, St Giles, Monks Road, Ermine, Birchwood or Moorland *
I give permission for my child to attend the Energize Activity Weekend, and for them to take part in all associated activities *
I understand that Energize cannot take responsibility if my child does not abide by Energize' rules *
I am happy for my child to appear in promotional photos/ videos *
I'm happy for my child to make their own way home from the coach drop off point after the weekend *
Please state any illnesses, conditions, special needs or dietary requirements we need to know about?
Your answer
This form will sign your child up to the weekend, however payment needs to be arranged separately in order to guarantee their place.
We are pleased to be able to run this weekend and the heavily subsidised rate of £28 per person (reduced from £75). What's the easiest way for you to pay? (The Energize team will contact you to arrange payment) *
Data Protection
For information on how your details are used, how we maintain the security of your information, and your rights to access information we hold on you, please see our full privacy statement on our website.
Acts Trust takes your privacy seriously, we will only use your information to provide our services. We also like to send information about our projects, events and volunteering opportunities. If you agree to be contacted in this way please tick the relevant boxes.
Acts was founded by Alive Church and work closely together. We would like to share your information with Alive Church so that they may send you information about their services and events.
A copy of your responses will be emailed to the address you provided.
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