Form Charity – reviveeventsuk

PRIMARY CONTACT INFORMATION

For all sections that are not applicable to you, please enter N/A

Full Name

Email Address

Mobile Number (Please enter 11 digits with no spaces and no +44)

Address

City/Town

Postcode

ATTENDANCE DETAILS

Are you registering as:

Number of Adults Attending

Number of Children Aged 5-16

Number of Children Aged 0-4

Total Number of Attendees

ATTENDEE INFORMATION

Full Name(s) of Adult Attendee(s)

Full Name(s) of Child Attendee(s) (if no children please write N/A)

Age(s) of Child Attendee(s)

Are you or any of your party reverts?

If yes, please confirm the names of all those who are reverts to Islam

Preferred Room Arrangement (If individual booking please write room with 4/5 beds)

ACCOMMODATION REQUIREMENTS

Preferred Room Arrangement (If individual booking, please select shared accommodation)

Do you require accessible accommodation?

If yes, please specify for example, Step-free access, wheelchair-accessible facilities, adapted bathrooms, hearing or visual support, or any other accessibility requirements.

DIETARY REQUIREMENTS

Please note that all food served during meal times will be halal.

Do you have any dietary requirements? (Please note that all food served during meal times will be halal. Breakfast, Lunch and Dinner will be provided).

If Other Please Specify

MEDICAL & EMERGENCY INFORMATION

Do you or any attendee have any medical conditions we should be aware of?

If Yes, Please provide details of any medical conditions, allergies, disabilities, or medications that event organisers should be aware of

Emergency Contact Name

Emergency Contact Number (Please enter 11 digits with no spaces and no +44)

Relationship to Emergency Contact

ADDITIONAL INFORMATION

How did you hear about us?

Additional Comments or Requests

PLEASE SEE LIST OF DECLARATIONS HERE

BY SUBMITTING THIS FORM YOU AGREE TO THE DECLARATIONS LISTED

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