Date: Friday 24-25th April 2026

Venue: Hill Dickinson

Ages: 5-16 years

Cost: £30 per junior & £10 per parent/guardian.

Please note juniors must be accompanied by a parent/guardian.

We require a minimum parent/guardian ratio: 1 adult to 3 children.

Everton in the Community is a registered UK charity with the charity number 1099366.

Parent/Guardian Information

Parent Counter

First Name :

Surname :

Email Address:

Phone Number:

I confirm that I will be attending the junior sleepout as the named parent/guardian

Address

Number and Street

City

County

Country

Post Code

Do you have any medical conditions?:

YesNo

Parent/Guardian medical condition details :

Do you have any Dietary Requirements ?:

YesNo

Parent/Guardian dietary requirements details :

Emergency contact name :

Emergency contact number :

Junior Attendees

Ticket Counter

Participant First Name

Participant Last Name

Date of Birth

Participants age

Photo consent?:

YesNo

Does this Participant have any medical conditions?:

YesNo

Attendee medical condition details :

Does this Participant have any Dietary Requirements ?:

YesNo

Attendee dietary requirements details :

Does the participant have a special education need and/or disability? (This may be diagnosed or undiagnosed.) ?:

YesNo

If yes, how does this affect day to day activity and what, if any additional support is needed? :

Number of Places

Places cost £30 per Junior & £10 for the parent/guardian place.

Payment will be deducted upon submission of this form.

Parent/Guardian Place

Price Per Place (£)

Total Cost (£)

Total Cost

Number of Junior Places

Price Per Place (£)

Total Cost (£)

Total Cost

Total Number of Tickets

Total Cost

Total Cost (Stripe)

Declaration

I agree to pay the registration fee's (as stated above) and each participant pledges to fundraise £60 for Everton in the Community

Card Information

Please select card type:

Card Number:

Expiration Month (MM)

Expiration Year (YY)

CVV Code:

Cardholders Full Name:

Cardholder's Email Address:

Final CVV Code: