First Name:  * Last Name:  * Male / Female:  * Church / Congregation:  * Date of birth (dd/mm/yy):  * Parents name(s):  * Email address:  * Mobile Phone number:  * Address:  * City:  * Postcode:  * Will you need to use the coach travelling from Central London or are you making your own way to camp?:  * Please list any special dietary requirements allergies illness or disability details that we need to be aware of (if none please write n/a)  * WAIVER & CONSENT: In an emergency and/or if I cannot be contacted I am willing for my child to receive necessary hospital or dental treatment including an anaesthetic. I understand that while at camp and involved in camp activities my child will be under the authority supervision and care of designated adults approved by the director of youth and children's ministry. I also understand that while those designated adults will take reasonable care of my child they cannot necessarily be held responsible for any loss damage or injury suffered by my child during or as a result of activity. Please bear in mind that the church or her agents cannot be held responsible for any loss or damage to personal property that you are bringing to camp. I have read the waiver & consent and I agree to it's terms. Please check box Yes No Mailing list signup:   Check this box to signup for our site mailing list. Security code:   * Do not enter anything in this field:

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