Camp Brochure 2016

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Camp Brochure 2016
2016
Castledaly Manor
We ask that Parent/Guardian complete form:
Winter (Ages: 14-17)
◻
Refocus (5th & 6th Yr students)
◻
Youth (Ages: 14-17)
◻
Home Phone: ___________________________
Parents Information
School: _________________________________
Forename: __________________________________
________________________________________
Surname: ___________________________________
Class_______________
Address if different: _________________________
____________________________________________
2nd - 4th Jan
18th - 20th Feb
Friends with whom you wish to share?
Home Phone: _______________________________
________________________________________
Mobile Phone: ______________________________
________________________________________
Email Address in block capitals:
10th-16th July
__________________________________________
Junior (Ages: 8-11)
17th
–
23rd
July
Senior (Ages: 11-14)
31st July
-
◻
6th
◻
Aug
*Please see website for ‘Fellowship work week’
application forms
Does the camper have any of the following
Please tick this box if you do not wish to receive
we should be aware of?
all camp information by email ◻
Consent
Please tick to accept:
• Medical Conditions: Yes___ No___
If yes, please state:
________________________________________
Camper’s Information (BLOCK CAPITALS Please)
________________________________________
Forename:______________________________
• Dietary Requirements: Yes ___ No ___
Surname:_______________________________
If yes, please state:
D.O.B: ____________________
________________________________________
Gender: ____________________________
________________________________________
Age at camp: ______________
Emergency Contact: _____________________
Home Address:
Phone Number: _________________________
________________________________________
Family Doctor’s Name: ___________________
________________________________________
Doctor’s Number: _______________________
________________________________________
Date of Last Tetanus Injection:_____________
• I, the Parent/Guardian hereby give my consent for ◻
the above named to attend BCM residential Camp.
• I give my consent for the above named to participate
in all on-site and off-site activities all under proper
◻
supervision
• I also consent to the above name being included in
photographs of the activities.
◻
In order that the camp be enjoyable for all, certain
rules must apply and I accept that the above named
must abide by these rules.
Signed: Parent/ Guardian
_________________________________________
I enclose: € __________
Cheques or Postal orders to be made out to
BCM Ireland
Return to:
Camps Administrator
[email protected]
BCM Camps,
Phone: 090 648 2222
Castledaly Manor,
www.bcmireland.ie
Athlone,
Co.Westmeath

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