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THE DORSET FEDERATION OF YOUNG FARMERS" CLUBS

South West Area Junior Activities Weekend 2019

Friday 16th August 2019 - Monday 19th August 2019

Acorn Adventure, Llangorse, LD3 7TR with 90 members from Cornwall, Devon, Somerset, Dorset , Wiltshire and Gloucestershire 3 days of action, adventure and water sports. For 10 – 17 year old members £128.00 per participant, includes accommodation, activities, food, travel, insurance and a Dorset T Shirt (half payment will be supplemented by Dorset YFC), travel will be by minibus/coach (collection point will be the Dorset YFC Offices at Kingston Maurward College) You will be "glamping" for the weekend with lots of exciting things planned! You will be taking part in activities such as kayaking, abseiling, high ropes, raft building, bush craft and much more. To book for the Weekend, please fill in the form (all participants must be paid up members of Dorset YFC and aged between 10 and 17. Complete this form and pay electronically or return a paper version with a cheque (details below). Further details (& consent forms) will follow nearer the time.

First Name *

Surname *

Member No: *

Address *

Home Tel *

Age *

DOB *

Mobile *

T Shirt Size *

Please can we have a parent email address so that we can forward the Parental Consent Forms and Events and Photography Forms. Thank you

Name of Doctor *

Doctors Address

Doctors Tel: *

Parental Consent and name of a person who can be contacted in case of an emergency (not someone who is going with you!!)

I agree to my son/daughter taking part in the SWA Junior residential in Brecon Beacon"s *

Yes

Contact 1 Name *

Contact 1 Relationship *

Contact 1 Home Tel: *

Contact 1 Mobile *

Contact 2 Name *

Contact 2 Relationship *

Contact 2 Home Tel: *

Contact 2 Mobile: *

Special Details: any relevant information regarding your child"s health or diet requiring special attention but which does not prevent him or her taking part should be noted below

Does your child suffer from any allergies (antibiotics, elastoplast, aspirin or foods), diabetes, epilepsy, bad period pains, or any other illness or disability? *

Yes No

If yes please give details

Is your child taking or receiving any medical treatment at present? *

Yes No

If yes please give details

Does your child have any special dietary requirements? *

Yes No

If yes please give details

Can he/she swim 50 metres? *

Yes No

Date of last anti-tetanus injection (if known) *

Any other information that you feel we should be aware? *

I consent to my child attending the SWA Junior Activities Weekend, 16th - 19th August at Acorn Adventure *

Yes No

I consent to my child being transported by coach or minibus to and from Acorn Adventure *

Yes No

I consent to any emergency medical treatment necessary. I authorise the group leader to sign on my behalf, any written form of consent should medical treatment be deemed necessary, if a delay to obtain mine was likely to endanger my childs health or safety. *

Yes No

I confirm that my child is in good health and I consider him/her fit to participate *

Yes No

I consent to photographs being take of my child during activities at the residential which may be displayed on our website or in advertising leaflets *

Yes No

My child understands full participation in all activities is expected.

Yes No

I confirm that should my child be required to leave the trip following discussions with the trip organiser, I shall make the necessary arrangements to collect him/her *

Yes No

Signature of Parent/Guardian

Print Name *

Accommodation request: (we will do our best)

My Products

GBP Junior Weekend 2019 Payment

Payment Details:You can pay direct with this form via Paypal OR you can send a cheque to the County Office made payable to "Dorset YFC" for £128.00 Please send full payment to Dorset YFC, Stinsford Business Centre, Kingston Maurward, Dorchester, DT2 8PY no later than Monday 3rd June 2019. Bookings are on first come first served basis within all the Counties. Your place will only be booked once we have received the full £128.00.

Please note the places are very limited and will be on a first come first served basis (sorry!), once we have filled our alloted spaces I will then put your on reserve also in order or acceptance.

If you do not have a PayPal account when you get to the payment area log in as a guest. Then select in country box UNTED KINGDOM the you can pay with any card (debit or credit)