CFC DEEP Youth Residential for 3rd 6th form / 18yrs Dates of visit: Friday 23rd Sun 25th

th September 2011. Arrive @ 18:30, and pickup @14:00. Venue: Castlewellan Castle, BT31 9BU (028 4377 8733) Description of activities: Mixture of indoor session-based activities (including teaching and worship), and outside recreational activities in the Newcastle / Mourne area (there may be short periods of time when your child is in a small group and unsupervised in Newcastle).

****Every attendee will go in to a draw to win a set of Nixon in-ear headphones worth 70***
Please return forms and full payment of 59 to the CFC office or Resources Desk FAO FINANCE, CFC, 10 Belmont Road, BT4 2AN (or email form to thehub@cfcbelfast.com) by Monday 5th September (cheques payable to CFC. Note: these residential weekends are for youth currently attending CFC youth provision on a regular basis. The youth team reserves the right to refuse application forms from those not typically known to us. Sibling discount of 9 applies to subsequent

attendees (so 59 for 1st child, and 50 per child thereafter. Transport to and from

Castlewellan will be your own responsibility and so wed encourage parents sharing the lifts! Costs cover food, accommodation and activities, but exclude tuck shop spending money and a 2.10 return bus fare in to

Newcastle if under 16 and 4.20 16+ yrs. There will also be an optional trip up Donard.

CFC DEEP Youth Residential for 3rd 6th form / 18yrs: 23-25 Sept11 I agree to (name of child) ___________________________________ taking part in this residential, their participation in the activities described above and have read the information sheet. I acknowledge the need for them to behave responsibly, and understand that my child / ren may be sent home in extreme cases of misbehaviour, at the discretion of the youth leadership.

MEDICAL INFORMATION (please circle your answers where appropriate) a. Any medical conditions, long-term illness or disability requiring medical treatment, including medication? YES/NO. If YES, please give brief details: ________________________________________________________________________ ________________________________________________________________________ b. Please outline any special dietary requirements of your child and the type of pain/flu relief medication your child may be given if necessary: ________________________________________________________________________ ________________________________________________________________________

c.

To the best of your knowledge, has your son/daughter been in contact with any contagious or infectious diseases or suffered from anything in the last four months that may be contagious or infectious? YES/NO If YES please give brief details: ________________________________________________________________________

d.

Is your son/daughter allergic to any medication?

YES/NO.

If YES, please specify:

_______________________________________________________________

e.

During the course of the weekend, there may be the opportunity for your child to have prayer to receive or be baptised in the Holy Spirit. Are you happy for your child to volunteer themselves should the opportunity arise for prayer and ministry in this area? Circle your answer. YES/NO

DECLARATION (for Youth Residential 23-25th Sept11)

I agree to (name of child) ______________________________ medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present. I will inform the group leader as soon as possible of any changes in the medical or other circumstances between now and the commencement of the trip.

Main parental / guardian details:

Home/mobile tel: _____________________________ /________________________________

Home address:_________________________________________________________________

Alternative emergency contact name: ____________________________________________ Home/mobile tel: _____________________________ /________________________________

Home address:__________________________________________________________________

DECLARATION OF CONSENT (by parent / guardian). I read, understood and am in agreement with the information provided and supplied on this application form.

Signed (parent / guardian) :___________________________________

Full name (capitals):_________________________________________

Date:______________________D.O.B. of child :____________

School Year: ______________

YOU CAN EMAIL THIS FORM BACK TO PAUL.FRANCIS@CFCBELFAST.COM, or post back to CFC, 10 Belmont Road, Belfast BT4 2AN. Forms also available on website / or Facebook: www.facebook.com/CFCBelfast