Duke of Edinburgh Gold Residential Registration Form Your Details Firstname Middlename: Lastname: Date of Birth: Date Visiting Shieling: Home Address Address Line 1: Address Line 2: Town: County: Postal Code: Parent\Guardian Details Parent\Guardian's Firstname: Parent\Guardian's Lastname: Telephone: Mobile: Email: 2nd Contact Details 2nd Contact Firstname: 2nd Contact Lastname: Telephone: Mobile: Email: Dietary, Allergies & Medical Details Dietary Requirements: We will try to create a menu that suits you, within what is reasonable, heathly and affordable! Some of the food will be produced on site from our garden and animals. If you have any dietary needs, allergies or particular requests please put details below. Medical Information (Medication, Allergies, Conditions etc) Participants over 18 can register themselves, those under 18 need their parents to read below and register them. The Shieling Project would like you to read the following carefully. It relates to the safety of you/your children and the safety of others. Once you have read it we would like you to click on the 'Register' box below as an indication that you have read and understood it. Completing this Acknowledgement of Risk in no way compromises your legal rights, nor does it release the Shieling Project from any of its obligations towards you. Camping and learning outdoors comes with a risk of personal injury. We have taken all reasonable steps to provide you/your children with the level of care appropriate to these activities. But you should be aware that certain risks remain which are always present outdoors, and which can not be eliminated without destroying the learning and the experience. You/Your children may encounter rugged and rough terrain, physical effort will be required, there will be environmental risks and hazards (e.g rain and mud), there will also be the risk of slips, falls, minor cuts, midges and ticks. The Shieling Project provides clear instructions and safety advice, and it is important that you/your child follows these.Within these boundaries our staff have a duty of care to you/your child, and we will do the utmost to provide a safe environment. The Shieling Project has adventure activity liability insurance, holds qualifications from the relevant National Governing Bodies, and adheres to the HSE guidlines for these activities. We have risk management and assessment, child protection, and health and safety policies. Copies of these, insurance certificates and qualifications are available on request. I am happy for photographs and film to be taken (by the Shieling Project) of the participants for use in reporting on the progress of the project. I consent to joining the Shieling project mailing list and recieve emails from time to time. I understand the Shieling Project will never disclose my personal details to 3rd parties. I understand that there will be a qualified leader present and that they will make decisions based on the situation. I am /My children are physically fit to undertake these activities - please give details of any relevant health issues above: As I am under 18, My Parents have read the above statements. By clicking the 'Register' button you are agreeing to the above statement.After you register the system will take you to the payment page.
