Open Award DofE – CI Adventures

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 *

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. *

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. *

Signature *

Clear

Kit & Equipment Hire

Please let us know what equipment that you require to hire. If you already have the equipment please select the relevant box so that we know you will bring your own equipment to the sessions. Prices are capped at a total of
£2/day for the training day
£5/weekend for the practice expedition
£5/weekend for the assessed expedition.
Fees can be paid on the day.

Walking Boots *

Cost £1/day

Waterproof Trousers *

Cost £1/day

Waterproof Coat *

Cost £1/day

Hat & Gloves *

Cost £1/day

Roll Mat *

Cost £1/day

Sleeping Bag *

Cost £1/day

Expedition Rucksack *

Cost £1/day

2 Strap Day Bag *

(no charge)

Additional Comments/Feedback

Use this box for questions, feedback or any additional information you would like us to know.

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