Weekend Away 2019 Signup – Ebenezer Chapel

It’s almost time for Ebenezer Chapels Weekend Away! Just like last year, we are teaming up with Jireh, St Michaels and Maitland on 18th October to 20th October for a brilliant weekend away! The full cost for the weekend is £50, and includes your food, transport, accommodation and everything else to make this weekend amazing! Use the below form to sign up!

Are you going as staff? Sign up using this form instead.

Select your church*
- Ebby Youth Groups
- Jireh Church
- Maitland Youth
- St Michael's Youth
Details
These details are for the child attending the Weekend Away.
Name*
First Name Last Name
Date of Birth*
Contact Email Address*
We will need to email you to keep you up to date about the Weekend Away.
Enter Email Confirm Email
Address*
Street Address Address Line 2 City ZIP / Postal Code
Dietary Requirements
Emergency Contact Details
Please enter the emergency contact details of a parent or guardian. DO NOT ENTER THE DETAILS OF THE CAMPER
Emergency Contact Name
First Last
Telephone Number*
Mobile Number*
Medical Details
Please enter the medical details for the camper.
Is medication required?
Please state type and dosage
Can it be self administered?*
It can be self administered
It can not be self administered
Doctor Details
Doctor Name*
Doctor Phone Number*
Doctor Address*
Street Address Address Line 2 City ZIP / Postal Code
Sleeping Arrangements
Please list the names of those you wish to share a room with below. (Subject to behaviour and room avilability)
Allow photos?*
During this weekend we will take photos and videos. The photos/videos may be used on social media, on this website and may be displayed during church services or groups. Please select whether you do or do not want photo's of your child to be taken
Yes, allow photos to be taken
No, photos are not allowed to be taken
Campers Agreement
Campers must read the below campers agreement, and confirm that they agree with it.

1. During the sessions there will be time spent looking at the Bible and in praise and worship. You are expected to respect this time and not disrupt it for others.
2. Aggressive and offensive behaviour or language will not be tolerated.
3. You are expected to respect each other, the leaders, other people’s property and the site itself. Therefore, boys and girls will not enter each other’s accommodation, and any damages should be reported to a leader.
4. Alcohol, illegal drugs, offensive weapons and tobacco are not permitted at Camp.
5. If you choose to bring a mobile phone, iPod, or any other electronic device it is your own responsibility and if used inappropriately, may be confiscated.
Parent / Carer
Parents must read below, and confirm that they agree with it.

I give permission for my child to attend the Ebby Youth Groups Weekend Away on 18th - 20th October 2019 and agree to the following:
1. For my child to receive first aid treatment by the dedicated staff.
2. In an emergency, for necessary medical treatment to be administered to my child at the nearest hospital if I cannot be contacted.
Staff*
Data
I agree that by submitting this form my data will be processed in accordance to Ebenezer Chapel's Data Policy, a copy of which can be found at EbenezerChapel.org.uk/Policies.
I agree

Details

Emergency Contact Details

Medical Details

Doctor Details

Campers Agreement

Parent / Carer