Gold Qualifying Expedition Information & Consent Form

Name of event

Gold DofE qualifying expedition

Part I – to be completed by the leader. The parent/carer* should retain a copy of all the information in Part I

Please return this form (electronically) to Helen Cook by 06/08/2022

Proposed activity(ies)

Walking whilst remotely supervised Camping Cooking

Location

Yorkshire Dales

Start date and time

8th August 2022 9:30am

Finish date and time

11th August 2022 4pm

Cost

£80 (already paid)

Travel/transport information

Parents to drop off and pick up

Additional Information

Drop off / pickup instructions: Please drop your daughter off at 9:30am on Monday 8th August at Burnsall Car Park, Bunkers Hill. Burnsall, BD23 6BS. The longitude and latitude are 54.045893, -1.953259 Please collect your daughter at 4pm on Thursday 11th August from Aysgarth Falls National Park Centre, Church Bank, Aysgarth, DL8 3TH. The longitude and latitude are 54.295065, -1.982885 An expedition kit list and information about how to pack your rucksack as well as the food you will need to bring can be found here www.girlguidingsouthyorkshire.org.uk/dofe-expedition-information

Part II – to be completed by the parent/carer of participants aged under 18.

This form can be returned electronically.

Participant’s full name *

Participant’s membership number

Age at start of event *

Unit name

Please provide details of any disabilities, health or access needs (including allergies) that are relevant to this event.

Please provide any extra information that will help us make the event accessible for your child (e.g. dietary requirements, requirement for a prayer space).

NOTE: Please label any medication with your child’s name and provide clear instructions for its use. If applicable, ensure that a spare, clearly labelled inhaler or EpiPen is brought to the event to be held by the first aider.

Emergency contact: Please give details of a person who will be contactable at all times during the event/activity

Name *

First

Last

Telephone 1 *

Telephone 2 *

Address *

Address Line 1

City

State / Province / Region

Postal Code

How do they know the participant? *

Consent *

I give permission for my child (named above) to take part in event: Gold DofE qualifying expedition and for the medication noted above to be administered (if applicable).

Parent/carer's name* *

First

Last

* Where the term parent/carer is used, this refers to the adult that has legal responsibility for this child.

Email (for details in Part I of this form to be sent to) *

Date *