Use the form below to sign up for Lourdes 2017.

Places are limited — don't miss out! 

Please make sure you have the following details before completing this form:

  • Passport details
  • European Health Insurance Card (EHIC)
  • Emergency contact details
  • Your doctor's name and contact details

When you have finished click 'submit' and you will see a thank you message appear.

Please read our PHOTO POLICY & GUIDELINES before agreeing to these below.

The information you provide on this form, including medical information, will be held by Lancaster Diocese Youth Service and will be shared with our tour operator, Mancunia Travel Ltd., and the organising committee and medical team of the Diocese of Lancaster Lourdes Pilgrimage. This information will be used to assist in planning and organising the pilgrimage and to ensure that we are able to provide appropriate care where required.


Name *
as it appears on your passport
If you prefer to be known by a different name
House Name/Number, Street, Town, Postcode
Date of Birth *
Date of Birth
(American Format)
Gender *
How do you want to travel to Lourdes in 2017?
Please let us know of any special dietary requirements you have.
You will need a Passport for this trip. If you are not an EU Citizen you may need to apply for a visa to travel to France - please ensure that you apply in good time
Passport Expiry Date
Passport Expiry Date
(American Date Format)
Please ensure that you are in possession of an EHIC for travel in Europe. EHIC is free and can be obtained from www.ehic, (Please note that EHIC is not a substitute for travel insurance)
EHIC Expiry Date
EHIC Expiry Date
(American Date Format)
Please give details of all medical conditions to ensure that we are able to provide appropriate care whilst in Lourdes. Please let us know if these details change before we travel to Lourdes.
Please give details of all medication you are taking. Whilst in Lourdes you will be responsible for your own medication unless you or your parent or guardian requests otherwise.
Are you generally fit and well? *
Are you able to get around without support, and able to help others on pilgrimage e.g. by pushing wheelchairs? (If you answer no, please give details above)
Doctor's Name *
Doctor's Name
Emergency Contact 1 *
Emergency Contact 1
Please provide details of someone we should contact in the event of an emergency whilst we are abroad. For under 18s this should normally be your parent or guardian
Their relationship to you
House Name/Number, Street, Town, Postcode
Emergency Contact 2 *
Emergency Contact 2
Their relationship to you
House Name/Number, Street, Town, Postcode
Behaviour Guidelines and Agreement *
I have read the Guidelines for pilgrims (link above) and agree to behave as described
Photo Policy and Guidelines *
I have read the Photography Policy (link above) and consent for photographs to be taken and used as described
Happy to receive news? *
We won't use your personal details for any other purpose without your consent. Would you like us to send you information about other events that are happening?
Parental Consent (if under 18) *
FOR THOSE UNDER 18 AT TIME OF TRAVEL I have read the terms and conditions of this trip (link above) and confirm I wish my son/ daughter to attend
Parent's Name
Parent's Name
Required for under 18s, optional for others
Form Completion Date
Form Completion Date
(American Date Format)