THE DUKE OF EDINBURGH'S AWARD DofE Enrolment With A School To be completed by a Parent or Guardian of participant. School Name*Select Your SchoolWaddesdon Church of England SchoolSir Thomas Fremantle SchoolBurnham Grammer SchoolMacintyre SchoolUnity CollegePebble BrookYear Group*Select Your Year GroupYear 9Year 10Year 11Year 12Year 13Award Level*Choose an optionBronze AwardSilver AwardGold AwardParticipants name*Date of Birth* MM slash DD slash YYYY Age*Likes to be known as* Male Female Address* Street Address Address Line 2 Town County Post Code Parent / Guardian Details:Please confirm whether you are the Parent or Guardian of the participant* Parent Guardian Parent / Guardian name*Parent / Guardian Email address* Tel Number - Day*Tel Number - Evening*Mobile NumberEmergency Contact Details:Emergency contact name*Emergency contact address if different from above Street Address Address Line 2 Town County Post Code Emergency contact tel number*Emergency contact relationship to participant*Participants eDofE DetailseDofE numberMedical Details: For safety reasons all participants must provide information of any disability or medical condition prior to joining. Any changes must be notified in writing. Does the participant have any disabilities / learning difficulties?* Yes No If yes, please give details.Does the participant suffer from any medical disorders?* Yes No If yes, please give details.Will the participant bring their own medication?* Yes No If yes, please give details.Does the participant have any allergies?* Yes No If yes, please give details.Which ethnic group do you consider the participant belongs to?* White Mixed Asian Black Other Declaration: Photo consent declaration I agree to images being taken of my son/daughter whilst on this trip which may be used in local publications, on social media, Action4Youth noticeboards or website to promote the work of Action4Youth (These images will not be used in any way that may be viewed as negative in tone, or that may cause offence, embarrassment or distress to the child or their parent/guardian). I give my consent for my son/daughter to participate in any activity taking place as part of DofE and to receive medical treatment as necessary* Yes No I understand that my son/daughter will take part at his/her own risk, and accept that no responsibility for accidents or injuries, or loss or damage to personal property rests with the supervisory staff, unless proven to be caused by their negligence. I declare that to the best of my knowledge my son/daughter is competent and medically fit to participate as part of the group. I agree that medical treatment may be sought and given if necessary in case of emergency. In the event of a medical emergency, a copy of this form may be required by medical personnel. I understand the information from this activity may be stored digitally. I agree that a similar activity may be substituted due to safety factors or weather conditions. I agree that in the event of my son/daughter being removed from the event due to his/her unacceptable behaviour that I will bear the costs of collecting him/her and returning him/her to home. I have read and understand the statement of risk assessment associated with walking and camping unaccompanied in wild country areas but with remote supervision by trained staff. Participants/parents are responsible for the condition and suitability of their own equipment. If any kit fails or proves to be inadequate during an expedition you will be responsible for any cost incurred should it need to be rectified. Application is not valid without acceptance.Data Protection The information you supply will be used by Action4Youth for administrative purposes within the terms of the Data Protection Act 1998. We shall not supply it to third parties.Consent* By using this form you agree with the storage and handling of your data by this website. To view our privacy policy click hereCAPTCHA