URCYA 2022 Registration Form

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Booking Form

Welcome to the United Reformed Church Youth Assembly Booking Form. Please fill in all fields below and book before 1 January 2022.

The age range for this event is Year 10/S3 to 25 years inclusive.

For further information on how your personal information is processed, please visit https://www.urc.org.uk/images/Children-and-youth/documents/CYW_Data_Privacy_Notice.pdf for our Data Privacy Notice.

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Attendee Details

First Name(s):*

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Surname:*

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Known as (for name badge):*

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Gender:*

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Address:*

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Postcode:*

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Telephone Number:*

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Email:*

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Date of Birth:*

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Age (on 28/01/2022):*

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Church Name (if applicable):

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Synod (or Denomination/College):

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Have you been to Youth Assembly before?*

Yes

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Next of Kin

First Name(s):*

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Surname:*

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Relationship:*

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Email Address:*

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Telephone Number:*

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Mobile Number:*

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Travel

Which day will you arrive?*

Friday

Saturday

Sunday

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How will you be travelling to Youth Assembly?*

Car

Minibus

Train

Other (please specify)

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A coach will be provided from Tamworth train station to Whitemoor Lakes on Friday 28th January 2022 and returning from Whitemoor Lakes to Tamworth train station on Sunday 30th January 2022. Will you need a seat on the coach?*

Yes – on both Friday & Sunday

Yes – only on Friday

Yes – only on Sunday

Maybe

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Requirements

Do you have any special dietary requirements?:

None

Vegetarian

Vegan

Gluten free

Dairy free

No nuts

Other

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Do you have an impairment?*

YesNoDon't want to say

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If yes, please tell us more:

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Is there anything we can do to help or support you?

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Do you have a particular wellbeing need that you would like our team to know about?:

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Costs

If money is an issue, please contact us on 020 7916 8683 or e-mail This email address is being protected from spambots. You need JavaScript enabled to view it. as financial support is available.

The cost of attending the URC Youth Assembly 2022 is:

£115 (if booked received on or before 11 November 2021)
£145 (if booking received on or after 12 November 2021)

Please tell us how your costs will be paid:

Please invoice my Synod/College/Denomination

I will send a cheque (made payable to ‘United Reformed Church’) – please invoice me

I wish to make an electronic payment transfer – please send me further details

I don’t know yet

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Skills / Talents

Youth Assembly is run by young people, for young people. Are there any gifts, skills or talents that you would like to offer that we might be able to utilise?

Please tell us if you would be willing to share:

Musical Gifts

I wish to be a part of the music group at Youth Assembly 2022

Yes

I wish to be a singer

I play an instrument: ___ and can bring it to Youth Assembly

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I play the:

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Other Gifts

I have the following gifts, skills, talents that I would like to offer for use at Youth Assembly:

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Ethnic Diversity

URC Youth Assembly is a safe and welcoming place for all young people, whatever their background or wherever they come from. Please help us to make this happen by telling us about your ethnicity.

I am:

White British
White Other (please specify below)
Black Caribbean
Black African
Black Other (please specify below)
Indian
Pakistani
Bangladeshi
Chinese
Korean
South American
Other (please specify below):
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White Other:

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Black Other:

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Other:

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Room Details

Most rooms have four beds (usually two singles and one bunk bed). If you would like to share with a friend(s) of the same gender (same or similar age – please note that under 18s and over 18s will be in separate rooms), please state their name(s) below and we will do our best to match you up.

I would like to share with:

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Small Groups

Is there a particular person you would benefit being in a group with?:

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Creche

A creche will be provided for participants’ children aged 0 to 5 inclusive. If you would like a creche place for your child, please indicate below and for how may children:

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Place(s) at £10.00 each (for 0 to 3 year olds):

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Place(s) at £57.50 each (for 4 to 5 year olds):

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A separate booking form will be sent to you.