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NCS Sign Up Form
Participant Details
Did Someone Refer You?
If you have been recommended by a friend please put their name here
Resident Confirmation
*
I confirm that I have read the statement below:
Inspire Guide Change is a provider of the NCS programme in Cambridgeshire and must have access to Cambridge for weeks 3 & 4.
Name
*
First
Last
D.O.B
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DD
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MM
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YYYY
Multiple Choice
*
Male
Female
Rather not say.
Jumper/T-Shirt Size
Please select
X-Small
Small
Medium
Large
X-Large
XX-Large
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Day Contact Number
*
Evening Contact Number
*
Email
Please indicate which NCS course you would prefer to attend:
*
Summer 2017 (Starting 17th July) 4 week programme
Summer 2017 (Starting 24th July) 4 week programme
Cadet Programme 2017
Autumn 2017 (Starting 20th Oct) 1 week + 30hrs
Spring 2018 (Starting 9th Feb) 1 week + 30hrs)
Ethnicity.... Please select
*
Please select
White British
Irish
Traveller of Irish Heritage
Gypsy / Roma
Any Other White Background
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed background
Indian
Pakistani
Bangladeshi
Any other Asian Background
Black Caribbean
Black African
Any other Black background
Chinese
Prefer not to say
Any other Ethnic Group
Friend Referral - If you would like to complete the programme with a friend then please put their details below:
Name
Contact Number
Name of Friend 1
Name of Friend 2
Name of Friend 3
Parent/Guardian First Name
*
First
Last
Relationship to participant
*
Parent/Guardian Address
Street Address
City
State / Province / Region
Postal / Zip Code
If different from previous address provided for the participant
Day Contact Number
*
Evening Contact Number
*
Email
Second emergency contact
Second emergency contact
*
First
Last
Relationship to participant
*
Second Emergency Address
Street Address
City
State / Province / Region
Postal / Zip Code
If different from previous addresses provided
Day Contact Number
*
Evening Contact Number
*
Medical Contact Details
Doctors Name:
*
Doctors Phone
*
Doctors Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Authorisation is given for NCS staff to administer First Aid and/or transfer my young person to
hospital should an emergency arise:
*
Yes
No
NCS includes new environments and challenges. Please help us keep your child safe and happy by
answering the questions below. My child:
Has special educational needs
Requires a same-gender group
Is in care or has recently left care
Requires access to prayer facilities
Other
Requires other special considerations (please specify above):
Please provide specific details regarding your child safety and happiness.
My child can swim 50 metres
*
Yes
No
Please note your child does not have to be a competent swimmer to take part in NCS
Name of the school/college my child attends:
*
Participation in the NCS programme involves physical activities and learning out in the local
community with businesses and the public. If your child has any medical conditions which could limit
their ability to participate in any of these activities (or are currently taking any medication
for any condition or illness) please provide full details below:
Wheelchair user or mobility difficulties
Mental health difficulties
Blind or partially sighted
Deaf or hearing impediment
Autistic Spectrum Disorder / Asperger Syndrome
Disability, special need or medical condition not listed above
Special dietary requirement or food allergy
Other
You must declare all information - it will not stop your child from gaining a place but will allow us to
keep them safe.
Please enter details of any other medical conditions, dietary requirements or allergies here:
Please provide specific details on any medical conditions or dietary requirement.
Medical Permission – please tick the appropriate box
*
My child can administer their own medication
My child will need assistance to administer their medication
Not applicable
Medical support at residential/camping events In the event of your child suffering from a common ailment would you agree to the following medications being offered to your child?
*
Yes
No
Paracetamol
Piriton/Chlorophenamine (to address allergies)
Ibuprofen
Contributions
The total cost of the NCS programme and residential is over £1,000. We ask parents/guardians to contribute £50 for courses towards this cost. There is no payment required if your child is entitled to Free School Meals, or was entitled when in secondary school.
Contribution Options
*
I agree that a contribution of £50 is required to secure my child’s NCS experience (This can be a £5 deposit followed by £45 at leave two months before you preferred start date)
I am exempt from payment as my child is entitled to Free School Meals
Payment Options
PayPal (Follow instruction after the form has been submitted)
By Phone (Please call 0844 4480 159) *Please allow 48hrs for us to process your form
Cheque (Payable to Inspire Guide Change)
Bank Transfer: Sort Code: 09-01-28 Acc No: 55244999
Please send cheques to PO BoX 316, Ely, CB7 9FS
Bursaries
Bursaries can be accessed in some cases to cover the cost of the contribution and the costs of accessing the programme e.g. if your child requires appropriate clothing to take part in outdoor activities. In particular, we will consider bursary applications from participants who are teen parents, not living with their parents, have caring responsibilities or those who do not have a parent/guardian who works.
Please tick here if you would like to apply for a bursary
Tick Here
No refund policy
No refunds are available for cancellations or non-attendance, unless under exceptional circumstances.
Confirmation
*
Yes I have read the 'no refund' policy and understand that refunds are not available for cancellations or non-attendance
Publicity and Media Statement
Throughout NCS participants take part in activities that support their personal development and promote community engagement. Occasionally staff, media and young people themselves record these activities using photographs or video. This content may be used to promote or champion the good work of NCS and its participants via newspapers, websites, social networks or other suitable promotional media. By taking part in NCS and not informing us otherwise, we assume both NCS participants and their parents/guardians accept that their image, video and comments may be used in public print, web use, display or broadcast. Any photos or videos used will be positive, and we are happy to share with you any media published. All images and footage is kept securely and will not be used for any other purposes than those stated above.
Please tick that you have read, understood and accept the Publicity and Media Statement
Agree
Code of Conduct
By completing and signing this application form both parent and applicant agree to the rules below: • NCS participants are expected to take part in all programmed activities. • Participants are not allowed to leave the residential or other site without permission from their Group Leader. • Participants are expected to follow any emergency procedure, such as a fire drill, as directed by their Team Leader or other staff involved in the NCS programme. • Participants are not allowed in other people’s rooms or tents. • There is a no alcohol policy throughout all elements of the NCS programme. • The possession, sale, purchase or use of any illegal substances is strictly forbidden. • NCS participants should not involve themselves in dangerous activities that will cause injury to themselves, other NCS participants or staff. • No one should engage in abusive or anti-social behaviour towards other participants or staff.
Please tick that you have read, understood and accept the Code of Conduct Statement
*
Agree
Personal Belongings Statement
I understand that each young person on the NCS remains responsible for their own property, clothing, and valuables and that neither the NCS Provider or Reed in Partnership Limited shall be held responsible for any loss, damage, or destruction which occurs to any such property, clothing, or valuables during the course of this programme.
Please tick that you have read, understood and accepted the Personal Belongings Statement
*
Agree
Travel and Collections Statement
It is the responsibility of the NCS Participant to travel to and from meeting points where transport has been pre-arranged and to travel directly to and from agreed venues where transport is not pre-arranged. Where transport has not been prearranged NCS Participants will be allowed to leave venues without collection and during the course of the activities NCS Participants may be required to undertake travel unsupervised, either by foot or by public transport.
Please tick that you have read, understood and accepted the Travel and Collections Statement
*
Agree
Information Update Statement
I will advise the NCS Staff, in writing, of any changes to information on this form prior to starting NCS.
Privacy Policy
The information you have provided will be held on computerised and paper-based systems that you may access under the terms of the Data Protection Acts of 1984 and 1988. By agreeing to us storing your name and contact information, you are agreeing for it to be shared and used by the Cabinet Office, NCS contractors and their sub contractors, NCS strategic partners, fraud detection agencies, and other organisations that support the delivery of NCS now or in the future. The information you give us may be used to contact you about your NCS application, graduate opportunities, events, research, promotions, competitions, and press and communications activity related to NCS. Our full privacy policy can be viewed at www.ncseast.co.uk/privacy. You can withdraw your consent by contacting ncs.east@reed.co.uk.
Attendance Policy
NCS has a limited amount of places. Each NCS place receives funding of over £1000 from the government. If young people give up their place close to the start of programme the place can be very difficult to re-fill, meaning wasted government funds and wasted opportunities for young people. Please help us by agreeing to the pledge below:
I will do everything I can to ensure I am able to fully complete my NCS Programme. If I cannot take part I will let my NCS provider know at least one month in advance.
Permission
By signing below, you have read and accepted all of the above statements.
Young Person's Name
*
Date Time
*
DD
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MM
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YYYY
Authorising Parent/Guardian Name
*
Date Time
*
DD
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MM
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