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REGISTRATION FORM FOR YFC NATIONAL CONFERENCE 2018

*Please use block letters when filling out this form


YOUTH NAME Male: Female AGE:

PERSONAL DETAILS EMAIL: MOBILE PHONE:

NAME OF ACTIVITY: YFC NATIONAL CONFERENCE 2018 DATE: 6 JULY 2018 TO JULY 2016

LOCATION Christian Youth Camp, 148 Waingaro Rd., Ngaruwahia 3720


TRANSPORT & ACCOMODATION REQUIREMENTS:

REQUIRE TRANSPORT DO NOT REQUIRE TRANSPORT

FRI & SUN (6 & 8 JULY) HE/SHE WILL DRIVE TO THE CONFERENCE

FRIDAY ONLY(6 JULY) SUNDAY ONLY (8 Jul) NOTE: YFC WITH RESTRICTED LICENCE ARE NOT ALLOWED TO
TAKE ANYONE WITH THEM.

(For Delegates outside Auckland only) (For Delegates outside Auckland only)

REQUIRE ACCOMODATION From: To: REQUIRE AIRPORT/BUS/TRAIN PICK-UP Arrival Date: __________
DROP OFF ON DEPARTURE Departure Date:____________
ONLY FOR YFCS DRIVING TO/FROM THE VENUE:
Photocopy of Full Driver’s licence has been provided to the YFC Coordinator? Yes No

Signed: Date: / /

Delegate
PARENTS CONSENT
I / WE
Father Mother Guardian
NAME/S

ADDRESS POSTCODE

EMAIL ADDRESS

ALTERNATIVE
HOME TELEPHONE MOBILE NUMBER
TELEPHONE

give my/our consent for him/her to participate in this 2018 YFC National Conference to be held at Christian Youth
Camp, 148 Waingaro Rd., Ngaruwahia 3720.
Agreement
 I agree to delegate my authority to supervising coordinator. Such supervisor/s may take whatever disciplinary action they deem necessary to
ensure the safety, well-being and successful conduct of the youth as a group and individually.
 In the event of an accident or illness and contact with me being impracticable or impossible, I authorise the coordinator-in-charge to arrange
whatever medical or surgical treatment a registered medical practitioner considers necessary. I will pay all medical and dental expenses incurred on
behalf of my child.
 I have also attached health care information, including details of any additional health support he/she requires to undertake the above activities
safely. I also consent to my child’s doctor or medical specialist being contacted in an emergency.
 The information given is accurate to the best of my knowledge.

Signed: Date: / /
Parent’s / Guardian’s Signature

Youth Medic Alert Number (If applicable):


Has the Medical Condition Information already been provided to YFC Coordinator? Yes No
Medical Condition Information

Child's Allergies (if any) _____________________________________________________

If your youth is under any medication, please indicate below:

Medicine For (state ailment) Dosage

____________________ ____________ _______ ____________________

____________________ ___________ _ _______ ____________________

____________________ __________ __ _______ ____________________

Special Dietary requirements

Any other concerns about your child that we need to know? (Youth’s personality, habits, interests, etc.)

______________________________ _ __________________
Parent's/Guardian’s Signature over Printed Name Date

*Any Medical Condition Information given will not prevent your child participating unless further medical advice warrants
exclusion. The Medical Condition Information you supply to the YFC Coordinator will be treated confidentially by the YFC
Coordinator. Such information is sought in order to protect and assist the Youth so the activity may be a safe and
enjoyable experience. Please contact the YFC Coordinator if you wish to discuss any Youth health care problems.