Crossley Heath DofE form 2024 (Bronze Group 3)

Parent/Guardian Emergency Contact Details

Parent/Guardian First Name *

Parent/Guardian Surname *

Parent/Guardian Email Address *

Home Phone Number *

Mobile Phone Number *

Additional Phone Number

Participant Details

What level would you like to enrol for? *

eDofE Number (if known)

Participant First Name *

Participant Surname *

Participant Email Address *

Mobile Phone Number *

Male/Female *

Age *

Date of Birth *

dd/mm/yyyy

First Line of Address *

Postcode *

Does the participant suffer from any of the following conditions, have any special requirements or recent injuries? *

Please tick ALL boxes that apply

Please provide additional details regarding your condition/requirements/injuries/illness etc *

Consent Details & Declaration

DofE: Consent to enrol from parent or guardian (if applicant is under 18 years old)
I agree to my son / daughter / ward doing a DofE programme. I note that it is my responsibility to check that any activity my son / daughter / ward undertakes for their DofE programme is appropriately managed and insured, unless the activity is directly managed or organised by their DofE group, centre or Licensed Organisation. *

C I Adventures: Participation and Medical Consent:
I give my consent to the person named above participating in the DofE Award. I have been informed of and have read the information relating to the activities. I have ensured that my child understands that it is important that for their own and the groups safety that any instructions given by staff must be complied with. I undertake to inform the staff of any changes in the health or medication of the person named above as and when necessary. I agree that staff from Creative International Adventures may, in the event of an emergency, give permission for the person named above to receive medical treatment *

Use of Mobile phones statement:
I understand that the use of personal mobile phones on expeditions is not permitted. A group mobile phone will be provided for emergency use only to allow the group to contact the supervisor or emergency services. In the event of taking a personal mobile on expedition it is likely that my son/daughter will be deferred and have to complete an additional expedition. The additional costs associated with that are not covered in the expedition package, so to complete the expedition section I would have to pay for the extra expedition. *

Permission to leave before programmed finish time:
Our session times are based on the normal time required to complete a set of tasks. In some instances students may complete all their required tasks before the published end of the session time. *

Model release agreement:
I give permission for any photographs or videos taken whilst involved in the activities to be used for promotional or presentation purposes. This may also be placed on the internet website. *

Supervision
I acknowledge that any training days and the Practice and Assessed Expeditions are remotely supervised events.
I also acknowledge that this supervision method, in conjunction with CI Adventures’ Camping Code of Conduct, is practised on camps too, with the level of Remote Supervision lessening from Bronze to Gold.

Cancellation
I have read and agree to CI Adventures’ DofE cancellation policy. Cancellation Policy

Signature *

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