Bookings now open To sign up please fill out this form below Please read the Good Behaviour Agreement: YWA Good Behaviour Agreement Youth Weekend Away Sign up here for the weekend away Parent/Carer with Parental Responsibility Email Address* Young Persons Full Name:*Date of Birth:*Young Persons Address:* Street Address Address Line 2 County / State / Region ZIP / Postal Code Your Address if different from Young Persons Address: Street Address Address Line 2 County / State / Region ZIP / Postal Code Name of Parent or Carer with Parental Responsibility First Last Relationship to Young PersonMotherFatherGrandmotherGrandfatherCarer/Legal GuardianOther (Please specify in 'Any Other Information'Paren/Legal Guardian Address (if different): Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Your Church:*Parent/Legal Guardian Phone Number*Photograph Consent*Photos may be taken throughout the weekend away for promotional use. Please note that we cannot prevent other young people taking photos and have no control over their use.Photos of my child can be used for KYFC purposesPhotos of my child cannot be used for any reasonMedical and Dietary Information*Please give details of any medical condition that you consider the group leaders should be aware of. Please also include any food allergies or dietary requirements. Please write 'None' if applicable.Have you read both the our Good Behaviour Agreement?*YesNoAny questions, please write them here:Payment InformationPayment (select 'Pay Now' or 'Pay Another Way' payment)*Pay NowAlternative method of paymentPlease select if you would like to pay online or offline.Pay Now* Pay Now - Please CLICK Payments can be made online now. Upon the submission of this form, you will be taken to a payment gateway to complete the payment.Bursary* Bank Transfer Deposit (£50) Bursary (agreed with KYFC) Sort Code - 405240 Account - 00012392 Reference - KYWA27 Then the SURNAME of the young person attending. Please note, Bursary Funding is available if required please email centre@kenilworth.yfc.co.ukOnline Payment TotalTotal £ 0.00
