Please complete one form per person

10:00am - 4:00pm each of the Saturdays



Please select the day(s) on which you'd like to participate below

Personal Details

Date of Birth:

Address:





Please outline your interest in evangelism

Details of GP

Details of any allergies/special needs

Please Provide two emergency contact numbers

Parent/Guardian Consent (under 18's only)

I give permission for:

  1. my child to attend the outreach selected on the dates highlighted
  2. To take part in the activities organised
  3. To be administered with first aid if needed, by a trained first aider or medical treatment given if needed by a suitably qualified medical practitioner. To the best of my knowledge, I confirm that the above details are correct.

Photograph Consent (all ages)

A signature is required for the below either for yourself if you are 18 or over, or by your parent if under 18:

  1. I give permission for photographs of my child/self to be taken during the outreach to promote future outreaches via
    media, Youth Council Website and Pamphlets, and to hold information given in this form.

Please sign using your finger or your mouse cursor in the box below: