RNC Activity Week Booking Form

Taking place between Tuesday 16 and Friday 19 February. Participants need to be aged between 14 and 17.

Participant Details

Participant's Name (Required)

First name Last name

Participant Known as

Participant's Preferred Pronouns (Required)

Participant's Home Address (Required)

Street Address: Town / City: County / Region: Postcode: Country:

Participant's Date of Birth (Required)

Participant's Email Address

Participant's Phone Number

Emergency Contact Details

Emergency Contact's Name (Required)

First name Last name

Emergency Contact's Relationship to Participant (Required)

Emergency Contact's Home Address (Required)

Same as participant

Different to participant

Emergency Contact's Home Address (Required)

Street Address: Town / City: County / Region: Postcode: Country:

Emergency Contact's Email Address (Required)

Emergency Contact's Phone Number (Required)

Vision Impairment Details

Is the participant registered blind or partially sighted? (Required)

Registered Blind

Partially Sighted

What eye condition(s) does the participant have? (Required)

How does this affect the participant? (Required)

Does the participant use a mobility aid? e.g. long cane or guide dog. (Required)

Please provide any other vision impairment information that you think may be relevant.

Medical Details

Please provide any relevant medical information (including allergies), details of other disabilities, or additional information we should be aware of during this activity. If the participant takes medication, please list it here. Note that all participants must be able to administer their own medication independently, as RNC staff and volunteers are unable to provide support with this. (Required)

Dietary information including any allergies. Please ensure this is as accurate as possible as this information is used to inform catering teams. (Required)

Please provide any other medical information that you think may be relevant.

Independence Skills

Please confirm if the participant can do the following tasks independently or with some assistance. If some assistance is required, please detail exactly what is needed.

Use of toilet (Required)

Independently

With some assistance

Use of toilet requires some assistance (Required)

Use of shower (Required)

Independently

With some assistance

Use of shower requires some assistance (Required)

Dressing (Required)

Independently

With some assistance

Dressing requires some assistance (Required)

Eating (Required)

Independently

With some assistance

Eating requires some assistance (Required)

Mobility (Required)

Independently

With some assistance

Mobility requires some assistance (Required)

General Information About the Participant

How would you describe the participant’s social skills and interactions with others? (Required)

Why did the participant choose to attend this activity? (Required)

What is the participant's first language? (Required)

Are there any activities the participant should avoid for medical or cultural reasons? (Required)

Please indicate the participant's preferred reading format/communication mode (e.g. print including font size, braille, audio) and give details of any specialist equipment and technology they use. (Required)

Is there anything else we should know about the participant?

Photography Consent

Do you give consent for the participant to be filmed and photographed during the residential activity? (Required)

Yes, I am happy for the participant be filmed and photographed

No, I do not give consent for the participant to be filmed or photographed

Activity Agreement

Please read the following carefully before agreeing, as it outlines the terms and conditions of participation in the RNC Activity Week:

I have read and understood the information provided about the activity residential.
I understand that the residential will take place from Tuesday 16th to Friday 19th February 2027.
I agree to behave responsibly at all times and follow instructions from RNC staff.
I confirm that the information provided in this booking form is accurate and I will notify RNC of any changes.
I understand that the cost of attending is £50.
I understand that places are not confirmed until payment has been received and that my place may be offered to someone on the waiting list if payment is not received by the required deadline.
I understand that payments are non-refundable if I withdraw from the residential.
Registered guide dogs are welcome at RNC. Buddy dogs are not permitted on campus.
In the event of an emergency or accident, I consent to any emergency medical treatment considered necessary.
I understand that if RNC is unable to meet a participant’s support needs, arrangements may need to be made for them to be collected.
I consent to RNC using the information provided to administer this event and to storing this information in accordance with applicable data protection legislation and RNC’s Privacy Policy.

Declaration and Consent (Required)

I confirm that I am the parent/guardian of the participant, and I have read, understood and agree to the terms and conditions above.

Parent/Guardian Confirmation (insert name) (Required)

Parent/Guardian Relationship to Participant Confirmation (Required)

Today's Date (Required)

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