Please complete and return a form - Brentwood Catholic Youth Service

Bradwell Pilgrimage: Booking Form
Saturday 4th July 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. Please let us know if you will arrange your own transport.
Details of timings and meeting points will be sent out nearer to the event.
Brentwood/Own Transport (please circle)
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 Bradwell Pilgrimage.
2. **I enclose full payment 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) or Roisin Lancaster (BCYS
Events Manager) 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 Friday 26th June- 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]