Activity Details

ACTIVITY DETAILS

ACTIVITY / LOCATION / DATE / COST
Qualifying Expedition & Residential Project / South Africa and Mozambique / 13th Aug –1stSept / £2495

PERSONAL DETAILS

NAME (Exactly as it appears on your passport)
DATE OF BIRTH (DD/MM/YYYY) / AGE ON 14TH AUG 2016
ADDRESS FOR CORRESPONDENCE / HOME TELEPHONE
YOUR MOBILE
EMAIL ADDRESS
EMERGENCY CONTACT NAME / TELEPHONE

PRELIMINARY MEDICAL DETAILS (A full Medical Questionnaire will need to be completed before starting your training)

Do you have any pre-existing medical conditions THAT ARE LIKELY TO AFFECT YOUR ABILITY TO UNDERTAKE THIS TRIP? / NoYes / Further details
Do you take any regular medication? / NoYes / Further details
Do you have any serious allergies? / NoYes / Further details
Do you have any dietary requirements? (Vegetarian / vegan etc.) / NoYes / Further details

PASSPORT INFORMATION

PASSPORT NUMBER / EXPIRY DATE
ISSUING COUNTRY / NATIONALITY CODE (eg. GBR)
DO YOU WISH TO EXTEND YOUR STAY?* / NoYes / IF SO, WHAT ARE YOUR TRAVEL DATES?

*If you extend your stay Canterbury Gold insurance will not cover you for this part of the trip

If you are travelling on a non-UK passport it is your responsibility to check there are no entry /visa restriction and that you are entitled to return to the UK. Your passport must be valid until 1st March 2017and have at least 4 blank pages.

We will require acopy of the photo page from your passport by 1st April 2016. If you are under the age of 18 before the 2nd September we will require additional documents to comply with South African immigration rules.

PAYMENT INFORMATION

We accept the following payment methods:

BANK TRANSFER (preferred) / CHEQUE
Account name: Canterbury Gold Expeditions
Bank: Santander
Sort code: 09-01-28
Account number: 01109062
Please reference participants name / Please make cheques payable to Canterbury Gold Expeditions and ensure that the participants name is on the reverse.
Post to Canterbury Gold, 11 St Lawrence Road, Canterbury, CT1 3EY

Payment may be made in four stages as outlined below or, if you prefer by standing order.

DEPOSIT / 1ST STAGE PAYMENT / 2ND STAGE PAYMENT / FINAL PAYMENT
£300 on booking (Non-refundable) / £400 before 31st December 2015 / £600 before 31st April 2016 / Balance, including any extras by 15th June 2016

PLEASE NOTE:

Submission of this booking form will only hold your place for 7days, within this time we must receive your signed consent form and deposit otherwise your place may be lost

In order to comply with the advice we have been given in relation to AAP’s we ask that if you are currently registered with a non-KCC Youth Service you transfer to Canterbury Gold at the time of booking on this trip or at least by the start of your training. This does not apply if you are already registered through KCC Youth Service.

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