Walsingham Pilgrimage: Booking Form Saturday 23rd May 2015 Name Date of Birth* Male/Female Address Postcode Telephone No. Mobile No. Email: Parent/ Guardian Email School School Year Parish *it is a requirement that either a parent or guardian complete the permission slip over the page. ** all correspondence will be via email. If you would prefer to receive information by post, please tick here. Please note any medical conditions (in confidence) Transport Coaches will be booked from Brentwood Cathedral. We will be in touch with you nearer the day with exact timings for the journey but we expect to leave Brentwood around 8am and arrive back at approximately 8pm Consent Form It is a requirement that either a parent or guardian complete this permission slip. All those attending must also sign below. 1. I apply for a place on the Walsingham Pilgrimage. 2. I enclose full payment of £15 to Brentwood Catholic Youth Service for a place at the event (Cheques payable to BRCDT Youth Service) 3. I agree that the money is not refundable unless:   I cancel before you incur any expenses or enter into any commitments You cancel the event for any reason, and some money remains after meeting all expenses and commitments. 4. I agree to authorise any adult leader that Kevin Ferros (Diocesan Youth Director) may delegate to sign any medical treatment consent forms as deemed necessary in an emergency on the advice of a qualified medical practitioner. I set out above details of any medical condition and treatment required. 5. I give permission for photographs of my son/daughter to be used for BCYS promotional purposes .* *Please note that we would now presume that photos taken by young people will be displayed on social networks such as facebook, Twitter etc. Please contact us if you have any concerns in relation to photographs Signed (Person attending) _______________________ Date __________________ Signed (parent or legal guardian) ______________________Date _______________ Contact Details Contact details of parent/guardian: Name: ________________________ Telephone no ____________________________ Mobile Tel No __________________________ Alternative contact (in case of emergency): Name: ______________________________ Relationship to young person: ________________ Telephone no ____________________________ Mobile Tel No __________________________ Closing date for applications is Wednesday 20th May- early application is advised. Confirmation of your place and more details will be sent when we receive your application. All forms and any queries to be addressed to: BCYS, Cathedral House, Ingrave Road, Brentwood, Essex CM15 8AT Tel: 01277 265286 Email: [email protected]