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Taize 2

This document provides information about a pilgrimage to Taizé, France for young adults from Sunday 29th May to Sunday 5th June 2016. It includes sections for personal details, medical history, photo release permission, consent to participate, and payment details. Participants must provide their name, address, date of birth, passport information, and emergency contacts. They must also disclose any medical conditions or dietary restrictions. Parents or guardians must sign the consent form and provide alternate contacts in case of emergency. A €100 deposit is due by November 27th, 2015 with the total cost of the trip being €420.

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6K views

Taize 2

This document provides information about a pilgrimage to Taizé, France for young adults from Sunday 29th May to Sunday 5th June 2016. It includes sections for personal details, medical history, photo release permission, consent to participate, and payment details. Participants must provide their name, address, date of birth, passport information, and emergency contacts. They must also disclose any medical conditions or dietary restrictions. Parents or guardians must sign the consent form and provide alternate contacts in case of emergency. A €100 deposit is due by November 27th, 2015 with the total cost of the trip being €420.

Uploaded by

api-269957065
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Event:

Taiz Pilgrimage 2016

Group:

Young Adults

Date:

Sunday 29th May to Sunday 5th June 2016.

Section A:

Personal Details

Name (as on your


passport):___________________________________________________________
Passport Number:___________________________________ Date of Expiry:___________________
Address:
__________________________________________________________________________________
__________________________________________________________________________________
Mobile phone number:________________________________
Home contact number:________________________________
Date of Birth:________________________________________
Nationality:__________________________________________
Email address:________________________________________

Total cost of trip to Taiz is 420. (This will be reduced with fund raising).
This includes flights, bus from airport and 1 weeks stay in Taiz.

Your Name:______________________________________
Birth:_________________

Date of

Section B: Medical History


(This information will be treated with the utmost confidence)

Do you, or have you suffered, from any of the following conditions:


Diabetes:

(Yes) (No)

Gluten intolerance: (Yes) (No)


Asthma:

(Yes) (No)

Heart condition:

(Yes) (No)

Depression:

(Yes) (No)

Epilepsy:

(Yes) (No)

Allergies:

(Yes) (No) If Yes, please specify:

Medications: [Name, dosage and frequency]


1.
2.
3.
4.
Dietary requirements:

European Health Insurance Card:


Do you have one?

Yes [

(This is mandatory)

No [

[If not, this can be obtained through your local Health Office]
Do you have Travel Insurance valid for the dates 29th May to 5th June
2016?

If yes, with whom? _______________________________________________

Section C:

Photo Release Permission

During the event, general photographs of our group may be taken.


Can we have permission to use these photos?

Please Circle

YES/ NO

Section E:

Consent to Participate

I hereby give permission for my son/daughter/ward to participate in the above


activity.

Signed:

(Parent/Guardian):

___________________________________________
Date:

_____________________
Address:

(if different)

Contact telephone Number:

(if different from above)

Please state the name and telephone numbers of available persons, during the
period of the activity, in the event of non-availability of parent/guardian, in the
contact and telephone and address above.
Name

Telephone

Mobile

100 deposit to be paid by Friday 27th November 2015.

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