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Consent Form (18+)
Rotterdam 2015: 15th National Selection Conference of EYP the Netherlands
I, ________________________________________ (name), born _____/______/19___ (date of birth) in _______________________________ (place of birth), have read and understood the rules and responsibilities outlined in the official Welcome Booklet of the 15th National Selection Conference of EYP The Netherlands in Rotterdam (6th – 9th February 2015) and agree to abide by these rules. I further declare to adhere to the alcohol and drugs policy of the National Selection Conference (as outlined in the Welcome Booklet) and accept that I will be excluded from the session and sent home at my own expense if I violate the rules of the event or if I violate Dutch law. Furthermore I will cover any damage on public or private property that I have caused during the event. I recognise that participation in physical activity involves the risk of injury to one’s person or property and acknowledge that by signing this document, I accept these potential risks. As part of the 15th National Selection Conference of EYP The Netherlands in Rotterdam, 6th to 9th of February 2015, I transfer the right to my picture to the European Youth Parliament the Netherlands (Stichting Europees Jeugd Parlement Nederland) and any media present at the event and give my consent to me potentially being interviewed by journalists. Place and date:
Signature:
Telephone number of emergency contact:
Please return this form to nationals@eyp.nl as soon as possible, but at the latest on Wednesday January 21st 23:59 CET.