Consent Form (18+) Delft 2014 14th 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 14th National Selection Conference of EYP The Netherlands in Delft (14 th – 17th February 2014) 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 14th National Selection Conference of EYP The Netherlands in Delft, 14 th to 17th of February 2014, 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.
Signature: Place and date:
Telephone number of emergency contact:
Please return this form to academicprep@eyp.nl as soon as possible, but at the latest on Wednesday February 5th 23:59 CET.