THE DUKE OF EDINBURGH’S AWARD – BRONZE EXPEDITION FOR WADDESDON SCHOOL PUPILS Step 1 of 5 20% This Bronze expedition is only for pupils who attend Waddesdon School* I confirm I am a pupil at Waddesdon School Name First Last Likes to be known as Male Female Mobile no.* Date of Birth* MM slash DD slash YYYY Address* Street Address Address Line 2 Town County Post Code Email address* School* eDofE number* Parents or Guardians:Contact 1Name First Last Mobile* Home or Work Tel. Email* Address* Same as participant Different to participant (New address) Address* Street Address Address Line 2 Town County Post Code Relationship with participant* Add a second contact Add a second contact Contact 2Name First Last Mobile* Home or Work Tel. Email* Address* Same as participant Different to participant (New address) Address* Street Address Address Line 2 Town County Post Code Relationship with participant* Medical / Disability / Special Educational / Behavioural Needs Information*If YES, it is important that you fully explain the condition, its management and - as appropriate - medical treatment including medication. (Please provide additional information if necessary). Yes No Details*Can Pain / Flu Relief Medication be given?*Please outline any pain relief remedies your son/daughter may be given if necessary. Yes No Details*Specific medical information and allergies*If YES, it is important to disclose details to us. Yes No Details*Special dietary requirements*Please outline any special dietary requirements for your son / daughter. Yes No Details*Date of last tetanus injection* Doctor's name* Surgery (full address required)*Surgery Phone no.* NHS number* Statement of Risk Action4Youth (A4Y) places safety as a top priority. Adventurous Activities involve some risk for the people taking part: we aim to keep these risks as low as possible. The chances of a serious injury are extremely low, but minor injuries (bruises, bumps and - less likely – minor fractures) are a possible result of taking part in Adventurous Activities. A4Y’s staff will minimise actual dangers by: Carrying out a careful assessment of all risks before commencing the activity Only using experienced instructors with the appropriate qualifications for the activity Giving clear safety instructions to everyone participating Ensuring equipment and clothing is well-maintained and suitable for the activity and the environment Ensuring activities are within the capabilities of the participants Asking participants to supply information on any medical conditions Ensuring good hygiene standards are kept We expect participants to co-operate with A4Y staff, to ensure safety of all participants by following instructions and answering questions honestly about any medical conditions or other information relating to health and safety.Insurance When you pay to register with the Duke of Edinburgh’s Award you automatically receive some personal injury and travel insurance but we advise you to take a look at the cover and decide if you wish to take out a further policy yourselves. See what the DofE provide at https://www.dofe.org/en/content/cms/leaders/insurance/Transport consent* I agree to my son / daughter / ward to travel in Action4Youth’s staff members personal cars if required during the DofE Expedition. 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). Declaration* I agree to my son/daughter taking part in the activities outlined above. 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.