Participants’ Application Form

Student Name
Home Address		School/Group Name
		School/Group Address
Home Telephone
Mobile Number		Name of PAL
Student Signature

N.B. The Cavan Centre has a zero tolerance on Drugs/ Alcohol. Any participant found in possession of or thought to be under the influence of Drugs/ Alcohol will be removed from the centre. The below signed Parent/ Guardian will be required to collect the above named participant should he/ she be found with or suspected of being under the influence of Drugs/ Alcohol. This applies to all participants irrespective of age.

 

Dietary requirements or medical conditions: __________________________

 

The adventure may involve water-based activities.

Parent’s/guardian’s consent to above-named young person’s attendance at Samba Adventure from the 12^th-16^th July 2004:

 

Signature of Parent/Guardian: ________________________________________

 

Full Name (printed): ________________________________________________

 

Contact Number: ___________________________  Date:__________________

 

Cost 70 Euro to be paid with application form before 14^th June 2004. Application forms to be returned to John Mc Gee, the President’s Award, Cana House, Cavan, Co. Cavan. Any queries contact John @ +353 8722 85654