Lourdes 2017 Youth booking form

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.

Make sure you read the "rules" here because that's what you are signing up for: Photo policy and rules which I need to know about,

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.

PLEASE NOTE YOUR PLACE WILL NOT BE CONFIRMED UNTIL A DEPOSIT HAS BEEN RECEIVED

Personal Information
Name *
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 Date Format)
Gender
Travel *
How do you want to travel to Lourdes in 2017?
T-Shirt size
Allergies? Can't eat? Please make sure you tell us everything!
Travel Documents
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,.org.uk. (Please note that EHIC is not a substitute for travel insurance)
EHIC Expiry Date
EHIC Expiry Date
(American Date Format)
Medical Information
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.)
Street Name, Town, Postcode
Emergency Contacts
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
Please provide details of a second emergency contact in case we are unable to contact the first
Their relationship to you.
House Name/Number, Street, Town, Postcode
Personal Agreement
Behaviour Guidelines and Agreement *
I have read the Agreement for pilgrims (link above) and agree to behave as described.
Photo policy *
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 (for under 18s)
Parental Consent
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.
Parents Name
Parents Name
Required for under 18s, optional for others.
Date of Agreement
Date of Agreement
(American Date Format)