Forms home Duke of Edinburgh’s Award (DofE) expedition consent 1Contact details2Consent IMPORTANT – This form must be completed by the parent, guardian or carer if the participant is under 18 years of age and by the participant if over 18 years of age. Name of particpant* First Last Address* Street Address Address Line 2 City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Date of Birth* DD slash MM slash YYYY Emergency Contact - during the activity/trip* Mum Dad Other Full name* First Last Contact number*Please re-enter contact number*Second Emergency Contact - during the activity/trip Mum Dad Other Full name First Last Contact numberPlease re-enter contact numberPlease give details of any medical condition e.g. allergies (general, or to medication, anaesthetics etc.) asthma, diabetes, epilepsy, etc.*Please list any required medication* Date of last tetanus injection DD slash MM slash YYYY Venue* Dates* Disclosure of Risk for Participants The expedition provider needs to draw your attention to the following risks which can be associated with outdoor activities. It is particularly important that you understand your responsibilities detailed below for your own safety, and that of others that are involved in activities with you. Duke of Edinburgh’s Award expeditions include adventurous activities as defined by the Health and Safety Executive. Staff are trained and qualified to lead in these environments and have a duty of care to make the activities as safe as is reasonably practical. However, adventurous activities by their nature are hazardous and cannot be completely risk free. Accidents can happen without any contributory negligence from the company or its staff. Staff will meet groups through the day, but if the group goes off their route there may be periods when the group has no staff contact, and when the staff do not know the group’s exact location. Participants are trained how to manage these journeys safely including going off route and dealing with emergencies. Each group has an emergency phone but may not always have a signal, so they are trained how to respond in this case. Participants are not allowed to use phones to contact home. I understand and accept the above statements and acknowledge the information received regarding the proposed event. I agree to take part in training and/or expeditions with the expedition provider and its staff. I understand and agree to the supervision and camping arrangements as far as reasonably set out in the information received. I agree I am fit enough to take part in the activities and that a DofE Expedition may be physically and emotionally demanding. I acknowledge the need for responsible behaviour on my part and any rules and instructions will be obeyed. I understand that the participant is responsible for the safe custody of their personal belongings and that the expedition provider cannot be held responsible for replacing any such personal belongings that are lost damaged or stolen or for compensation of any kind. Environments & Situations that you may encounter include: Rough / rugged terrain: this may cause you to experience greater than usual strain on joints and muscles. Physical effort: our activities may involve you in a greater level of exertion than in your usual day-to-day environment. Height:whilst appropriate safety precautions are taken, some people can find situations at height to be stressful. Natural environment: most likely to be a rapid and significant change in the weather or unstable/slippery conditions underfoot, but can also include rock falls, lightening etc. Slips, trips and falls: the most common cause of accident throughout society, the opportunity for slips, trips and falls is likely to be greater than that which you usually experience. The expedition provider will as far as reasonably practically ensure as safe an environment as possible for each activity. As a participant you also have a responsibility for safety. Your responsibilities are as follows: Medical: please make us aware of medical condition(s) or injuries, past or present, which may affect or make ill-advised your participation in any activity. We can then agree with you whether you should participate. Fears & phobias:before commencing any activity, please ensure that we are aware if you have any major concerns, fears or phobias about the situation(s) in which you are choosing to place yourself. We will work with you to help ease your feelings of anxiety, apprehension, fear and ensure that you are as comfortable as possible. Drugs & alcohol: it is potentially highly dangerous to participate in any activity whilst under the influence of drugs or alcohol. The expedition provider reserves the right to prevent any person participating in any activity, should we suspect that they may be under the influence of drugs or alcohol. Instruction: you must accept and act upon all direction and instruction from our staff. Sleep: It is extremely important that you get enough sleep to carry out the next day’s walking. The expedition provider reserves the right to phone parents at any time of night and request collection of a young person if they refuse to settle down during lights out and take adequate rest. Consent of adult* I confirm my understanding of all arrangements as set out and consent to the young person in my care taking partEmail* Please state your name and relationship to the young person* Consent of young person* I understand and agree to follow the rules stated above and comply with the instruction given by the expedition leader and other members of staff during the weekend expedition.Date* DD slash MM slash YYYY Terms and Conditions* I have read and agree to the terms and conditions.
