Clone of 2025 South West Area Junior Camp Young Person Registration Form

PLEASE NOTE

Following an increase in the number of spaces avalaible on the trip bookings have now reopened for all. Once all spaces have been filled this form will be disabled and you will be unable to purchase a place on the trip.

Places are sold on a first come first served basis.

If you have any questions please contact me using the details at the bottom of the form.

Pip

Young Person information

Young Person's Name*

First NameLast Name

County*

Club*

2025/26 Membership Number*

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Gender*

MaleFemale

Date of Birth (must be 17 or under on 24 August 2026)*

Date

T-shirt size*

Parent/Guardian Information

Name*

First NameLast Name

E-mail*

example@example.com

Mobile phone number*

Medical Information

Name of Doctor

Doctors Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Doctors Tel:*

Area CodePhone Number

Date of last anti-tetanus injection (if known)

Does your child suffer from any allergies (antibiotics, elastoplast, aspirin or foods), diabetes, epilepsy, bad period pains, or any other illness or disability?*

YesNo

If yes please give details:

Is your child taking any medication or receiving any medical treatment at present?*

YesNo

If yes please give details:

Does your child have any special dietary requirements?*

YesNo

If yes please give details:

Special Details: any relevant information regarding your childs health or diet requiring special attention but which does not prevent him or her taking part should be noted below. Any other information that you feel we should be aware?

Emergancy Contacts

Emergency Contact 1*

First NameLast Name

Contact 1 relationship to young person*

Contact 1 mobile number*

Emergency Contact 2*

First NameLast Name

Contact 2 relationship to young person*

Contact 2 mobile number*

Permission

I consent to my child attending the SWA Junior Activities Weekend, 21st - 24th August 2026 at PGL Boreatton Park (Shropshire).*

YesNo

My child understands full participation in all activities is expected.*

YesNo

I consent to my child being transported by coach or minibus to and from PGL Boreatton Park, Shropshire.*

YesNo

Please confirm your childs swimming ability:*

My child can swim 50 meters or more.My child is water confident (can duck head underwater & swim 15 meters in a life jacket without panicking).My child is unable to swim.

I consent to any emergency medical treatment necessary. I authorise the group leader to sign on my behalf, any written form of consent should medical treatment be deemed necessary, if a delay to obtain mine was likely to endanger my childs health or safety.*

YesNo

I confirm that my child is in good health and I consider him/her fit to participate.*

YesNo

I consent to photographs and videos being take of my child during activities at the residential which may be displayed on our website or social media and used in advertising.*

YesNo

I confirm that should my child be required to leave the trip following discussions with the trip organiser, I shall make the necessary arrangements to collect him/her.*

YesNo

Signature of parent*

Print Name (parent)*

First NameLast Name

Accommodation request of who you would like to share a cabin with: (we will do our best to make sure everyone is with at least one person they know)

Confirmation: By acknowledging and signing the below I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.

Payment options:

There are two payment options:

1 - pay 100% at the time of booking.

2 - pay 25% now and a further 25% by 1 April 2026, 1 May 2026 and 1 June 2026.

Payments made under the payment plan are NOT refundable once made. Any payment not made on time may result in withdrawal of the place on the trip, no refund will be avaliable for payments already made . No additional charge will be made for using the payment plan. One email reminder will be sent approx 2 weeks before each payment date with details of how to make the next payment.

PLEASE CHOSE YOUR PREFERED PAYMENT OPTION BELOW (DO NOT SELECT BOTH!):

My Products*

100% Booking costTo include transport, accommodation (excluding bedding), meals, activities and T-shirt.

£215.00

25% Booking cost - payment plan optionTo include transport, accommodation (excluding bedding), meals, activities and T-shirt.

£53.75

Total

£0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

FURTHER INFORMATION (PLEASE READ):

Bookings are non refundable. If you are unable to attend, and a replacement is found, the cost of the booking, less the transaction fee, may be refunded to you.

Once bookings have closed the busses will be finalised and ONLY THEN will you receive any further information about the trip. Additional information about the trip will be circulated in the first week of June.

Please expect to be leaving on the Friday morning and returning home on the Monday afternoon/evening.

If you have any questions about the weekend in the meantime please contact the weekend organiser - Pip Cusack - 07887534111 or swajuniorcamp@outlook.com

South West Area Junior Camp Young Person Registration 2026