Sleep Easy 2017 - Registration Form

Frome Youth & Community Centre, Vallis Road, Frome

Friday, 3rd March at 8pm

Name ______

Address ______

Postcode ______Tel No ______

e-mail ______

Emergency Contact Name ______

Address ______

Postcode ______Tel No ______

e-mail ______Relationship to you ______

I would like to register to participate in YMCA Mendip’s Sleep Easy 2017 and agree to the terms and conditions overleaf.

Signed ______Date ______

Please return to Karen Collins, YMCA Mendip, The Old Glasshouse, South Street, Wells,

BA5 1SL or e-mail to

Thank you for your support

Terms and Conditions

  • Participants under 16 years old must be accompanied by an adult at all times
  • No smoking on the sports court – designated smoking areas will be made available
  • No alcohol or drugs on site, participants will be asked to leave if they arrive under the influence.
  • No naked flames on the sports court
  • Sorry, but no dogs can be allowed on site (excluding assistance dogs)
  • Participants to take all their belongings away with them and leave the site clean and tidy
  • Fire extinguishers are available in the Youth & Community Centre.
  • If the weather gets too bad the event will be moved to the sports hall in the Youth & Community Centre.
  • The latest any participant can arrive to take part in the sleep out is 10:00pm
  • No music after 11:00pm
  • At midnight participants will be required to take their allocated places within the court to sleep.
  • Participants must bring appropriate equipment and clothing. If it is felt a participant has inadequate clothing and equipment for their own health and safety they will be asked to leave.
  • All participants are responsible for their private possessions and personal safety.

Kit List

  • Coat, hat, gloves, scarf
  • Waterproof clothing
  • Change of clothes if likely to be wet
  • Blankets/sleeping bag/pillows
  • Cardboard box
  • Food and drink (non-alcoholic)
  • Torch

Please remember that we will be sleeping out for the night. The weather in the UK is unpredictable at the best of times, so come prepared as it may be a cold night. However, remember why we are doing this; for you it is for one night only, others don’t have anywhere else to go.

Thank you for your support

Sleep Easy 2017 - Sponsorship Form

Participant’s Name
Address
Postcode
E-mail Address
Contact Telephone No

Please support me on 3rd March 2017. I will be sleeping rough at Frome Youth and Community Centre, Vallis Road, Frome, to raise awareness about youth homelessness and to raise vital funds for YMCA Mendip.

FULL NAME
/ HOME ADDRESS AND POSTCODE
(needed for gift aid purposes only) / £ PLEDGED / DATE COLLECTED / GIFT AID
see overleaf / RECEIVE FURTHER INFO
Brought forward from previous page / £
Total Raised / carried forward to next page / £

Please sign, date and return your completed sponsor form and payment by 3oth March 2017 to Karen Collins - Tel: 01749 679553 Email: Please make cheques payable to Mendip YMCA.

YMCA Mendip will process your data in relation to our charitable purposes. We will not pass on your personal details to any other organisation. We would like to keep you informed about our work. If you would prefer not to receive updates about YMCA Mendip’s work in the community please state ‘no’ above.

Gift Aid Declaration

Boost your donation by 25p for every £1 you donate

 I want to Gift Aid my donation of £______and all future donations to YMCA Mendip.

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.

(If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.)

Donor'sdetails

Title ______First name or initial(s) ______

Surname ______

Fu11homeaddress______

______

Postcode ______

E-mail ______

 I confirm that I am happy to be contacted by YMCA Mendip in the future via telephone/post/e-mail (please delete as appropriate).

I do not wish to be further contacted by YMCA Mendip.

Signature ______

Date______

Please notify YMCA Mendip if you want to cancel this declaration; change your name or home address or no longer pay sufficient tax on your income and/or capital gains.