Limitless Registration form 2024 Year 10- Year 13
Parent/Guardian Details
The Parent/Guardian details provided will be used as the first emergency contact and to communicate about Fearless.
First name
Last name
Email
Mobile
Second Emergency Contact Details
Please provide details of a second person to be contacted in case of an emergency. We will attempt to contact the first emergency contact before using the second contact provided.
Emergency Contact Name
Emergency Contact Mobile
Participant Registration
Please provide the following details for each young person you are registering. To complete the registration details for more than one young person select "add another response" at the bottom of the box below.
Youth Group you are attending with:
Cardinal Griffin
Cardinal Wiseman
Christ the King- Coventry
Edge- Alton
Edge- Nuneaton
OLAS Youth Group
Other
St Josephs- Thame
St Margaret Mary
St Mary Immaculate
St Rose and St Peter
Trinity
Our Lady and St Werburghs, Clayton
St John Fisher and Sacred Heart
If other- what is the name of your Youth Group or if you are not attending with a Youth Group, please write individual in this box:
Young persons details
First Name
Last Name
Date of Birth
dd/mm/yyyy eg: 21/03/2010
Gender
Male
Female
Does not identify as male or female.
Can the Young Person ride a mountain bike?
Yes
No
Year Group
Year 10
Year 11
Year 12
Year 13
House name/Number and Street
City
County
Postcode
Does the participant suffer from asthma, allergies, diabetes,
epilepsy or and other medical condition that may affect normal
activity?
Yes
No
Please give details of condition & treatment.
Does the participant have any special dietary needs or food allergies?
Yes
No
Please give details
For example vegetarian, nut allergy etc
Parish Attended
Please include Parish name and area, for example: St Mary, Willenhall.
School Attended
CONSENT
Consent to store your information
The information you have provided in this form will be retained by the Kenelm Youth Trust , shared with the group leader of your youth group and used for the purposes of communicating with you about the event you are registering for and other opportunities that might be of interest to you. This information will be stored securely for 3 years. If at any point you want this information deleted please email: kristi.doughty@kenelmyouthtrust.org.uk
I consent to my information being stored and used as detailed above
Medical Consent
In the event that I cannot be contacted by ordinary means, I give permission and consent for my child/young person to receive any necessary medical treatment and authorise the group leader/person in charge to sign any medical documents required by the hospital authorities.
I consent to my child/young person receiving necessary medical treatment in the event I cannot be contacted.
Consent to Activities
I consent to my child taking part in on site castle activities that may include, biking, climbing, abseiling, trekking, archery fire lighting, survival or low ropes. (please be advised that young people will take part in a selection of these activities and we can't promise which ones so please be cautious in sharing this information with them - we wouldn't want to disappoint anyone!)
I consent
Consent to be added to the mailing list
KYT send out email newsletters once or twice per month about opportunities for young people and those who work with them. It is one of our key ways of communicating the many great opportunities offered by the Trust.
You can unsubscribe or change your preferences at any time.
Please sign me up to the monthly newsletter
Media Consent
My child and I consent to photographs and video's being used to share about the work of the Kenelm Youth Trust on our website, social media, publications and presentations.
If an error code appears and stops the form from being submitted, p
lease email kristi.doughty@kenelmyouthtrust.com who will be able to assist you.