South England Conference of Seventh-day Adventists

JUNIOR YOUTH MINISTRIES

APPLICATION FORM

GUARDIAN CONSENT FORM

JUNIOR CAMP 2015

By booking a place it is understood that the attendee wishes to join in the general activities of a Christian Camp.We hope that the juniors attending this year’s camp will make new friends, learn new skills and developa closer relationship with God.
Organisers: / SEC Children’s Ministries
25 St John’s Road
Watford, WD17 1PZ
Proposed Visit or Activity: / SEC Junior Camp
Date: / 27 July - 2 August 2015
Venue/Destination: / Chapel Porth Caravan Site
Goonvrea, St Agnes
Cornwall, TR5 0RN
Transport Arrangements: / Coaches & minibuses
Total Cost: / £125(includes transport to/from SEC Office, activities, food and accommodation)
Booking Deadline: / Monday 20 July 2015

This consent form has four sections and requires four signatures. Although it may appear to be repetitive we require all four places to be signed and dated to fully comply with Child Protection legislation. Please be aware that while the information requested on this form can be completed by a carer, only those with parental responsibility can sign the consent (NB: this does not necessarily include foster carers.)

Please complete a separate consent form for each child attending the camp. Your child may take part in various outdoor, indoor and water based activities that involve physical strength. Some of these activities such as those that require juniors to be able to swim are described as ‘medium’ or ‘high risk’. Exact activities will depend on the numberof juniors attending, butmay include: climbing, abseiling,swimming, paint-balling, surfing, kayaking, windsailing and mountain-biking. Activity centres visited will be fully insured, and will provide all the qualified staff needed for activities.

If you have any questions about the camp, please contact the SEC Children’s Ministries Departmenton 01923 23 27 28 or .

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Child’s Details

Full Name of Child/Young Person
Date of Birth / / / / / Gender / Male Female
Address
Post Code

Primary Contact

Name of Parent/Carer:
Relationship to Child
Day Tel / Eve Tel / Mobile
Email

Secondary Contact

In case we are unable to make contact with you in an emergency e.g. 2nd parent, grandparent, etc.

Name
Relationship to Child
Telephone

Parental Responsibility

If you do not have parental responsibility (e.g. you are a foster carer, grandparent etc) please give details of those with parental responsibility:

Name(s)
Telephone
Address
Post Code

Health Information & Medical Consent

Name of GP / Telephone
Address
Post Code
NHS No / Date of Last Anti-Tetanus Injection / / / /
Details of Any Illnesses/Disabilities/Allergies/Educational or Behavioural needs, etc.:

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Details of Any Medication Required During the Camp (all medication to be labelled correctly
and clearly with name and dose needed each day)

Medical Consent

In an emergency and/or if I am not contactable, I am willing for my child to
receive doctor/hospital or dental treatment including an anaesthetic.
Signed / (parent/adult with appropriate responsibility)
Print Name / Date / / / /

Swimming Ability & Activities Consent

Details of any regular medication, medical problem (e.g. asthma, epilepsy, diabetes, allergies, dietary needs, etc.) or disabilities which may specifically affect the swimming
activity and/or activity where being able to swim is essential

Swimming Ability (tick as appropriate)

Is your child able to swim 50 metres? / Yes / No
Is your child water-confident in a pool? / Yes / No
Is your child confident in the sea or in open inland water? / Yes / No
Is your child safety conscious in water? / Yes / No

Consent

I give permission for my child to take part in the specified camp and, having read the information provided, agree to him/her taking part in the activities described. I understand that while involved my child will be under the control and care of the group leader and/or other adults approved by the South England Conference leadership and that, while the staff in charge of the group will take all reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child during, or as a result of, the activity. I confirm that my child is in good health and I consider
him/her fit to participate.
Signed / (parent/adult with appropriate responsibility)
Date / / / /

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Using Images of Children

We often take photographs(and occasionally video recordings) of camp events and activities, which may include your child. Images taken during the camp may appear in our printed publications, on our website, or both.

To comply with the Data Protection Act 1998, permission must be granted by a parent/carer before any images of your child are taken and used.

To the Parent

  1. May we use images that include your child in our printed promotional

publications? / Please tick: / Yes / No
  1. May we use images that include your child on our website? (Please note that
websites can be seen throughout the world, and not just in the United Kingdom,
where UK law applies.) / Please tick: / Yes / No
Signed / (parent/adult with appropriate responsibility)
Date / / / /

Transporting Children

The SEC is able to provide transport to and from ChapelPorth by coach. The main collection point will be the SEC office in Watford, and any additional pickup points will be agreed depending on the geography of attendees. Juniors will be transported around Cornwall by minibus and the following principles will be adhered to:

  • Transport will be provided in vehicles that are roadworthy, i.e. covered by MOT and appropriate insurance.
  • All minibus drivers are over 25 years of age and have held a full driving license for at least 3 years.
  • Seat belts will be worn at all times by all occupants of the vehicle.

Consent

I give permission for my child to be transported as detailed above.
Signed / (parent/adult with appropriate responsibility)
Date / / / /

Please return your application form together with your full payment to:

SEC Children’s Ministries, 25 St John’s Road, Watford, WD17 1PZ

Please make cheques payable to ‘South England Conference’, or call Children’s Ministries Secretary, Anna McLarty, to make a credit/debit card payment over the phone.

tel : 01923 232728 / fax : 01923 250582 / email :

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