raft building and racing session for schools in dorset

DofE Registration Form

Please complete the form below to register for your DofE Gold Residential at Cumulus Outdoors.

"*" indicates required fields

DD slash MM slash YYYY
Residential Type*
Name*
DD slash MM slash YYYY
Address*
Including those due to religious beliefs. Please enter N/A if not applicable.
Please disclose all conditions so we can safely include and enable your child/yourself to achieve on this residential. Include allergies, recent surgery, asthma and any other relevant conditions. Please enter N/A if not applicable.

GP Details

Doctors address*

DofE Information

Address*

Emergency Contact Details

Emergency contact 1 number*
Emergency contact 2 number*

Confirmation

The information I have given is correct and I will notify Cumulus Outdoors of any changes. I agree to inform Cumulus Outdoors in writing as soon as possible of any change in the medical circumstances between the date signed and the start of the activity. I will bring with me my logbook or eDofE printout for the Assessor to view prior to the AAR and I am happy for my email address to be distributed to other participants where necessary.
Consent*
Participant signature*

Parent/Carer consent

To be completed by parent/carer. Please provide all of the following information regarding your son/daughter/ward:
Adventurous activities (stand alone or as part of a residential programme) are physical and demanding sports, which obviously have inherent hazards associated with them. Cumulus Outdoors takes all necessary precautions to try and ensure the safety of all participants. Each participant should familiarise themselves with the hazards and try and minimise these as much as possible by complying with Cumulus Outdoors’s risk management guidelines which are available upon request. Furthermore, it is understood and agreed that individuals participate at their own risk and that accidents can happen without any contributory negligence from the centre or its staff. In addition, Cumulus Outdoors can accept no responsibility for loss or damage to personal property or for personal injury not arising as a result of its own act or default. If the participant does not adhere to instructions given (for their safety and the safety of the others in the group) we reserve the right to remove them from the activity. I hereby declare that Cumulus Outdoors have fully explained the risks inherent to adventurous activities, and that I fully understand the risks involved and wholly accept these risks as part of the activities enjoyment. 1. I agree to my son/daughter/ward* taking part in the activity with Cumulus Outdoors and have read/received the information. 2. I agree to them taking part in any or all of the activities arranged. 3. I consent to any immediate emergency medical treatment required by my child/ward during the course of the visit. 4. I confirm that my child/ward is in good health and I consider them fit to participate.
Parents signature*
DD slash MM slash YYYY
Are you happy for them to partake in water based activities*
Can they swim*
Medical emergency procedure*
In the event of illness or accident requiring emergency hospital treatment I authorise Cumulus Outdoors or an agent acting on their behalf to sign any written form of consent required by the hospital authorities on my behalf if a delay to obtain my signature is considered to be inadvisable by the doctor or surgeon concerned.
Sub-contracted activities*
The following activities are sub-contracted and run under their own insurances and procedures: Dorset Adventure Park - Waterpark and Mudtrail activities Pierhead Watersports - Powerboat RIB rides Swanage Angling - Mackerel fishing I authorise Cumulus Outdoors to sign any written form of consent required for the activities (subject to programme) on my behalf
Video consent*