annex e to
CACF 3067
Dated 26 Apr 14
CADET APPLICATION TO ATTEND CLEVELAND ACF ANNUAL CAMP 2014
SENNELAGER, GERMANY 9TH TO 23RD AUGUST 2014
My child (FULL NAMES) ______will be taking part in Annual Camp 14.
My child’s detachment is ______and I enclose full payment of £80.
Date of Birth: ______
Address: ______
Passport Number: Expiry Date:
EHIC Number : Expiry Date:
T-Shirt Size: (for free Annual Camp Polo Shirt)
I certify that my child is over 12 years of age and I agree to my child attending Annual Camp with Cleveland Army Cadet Force in Sennelager, Germany, between 9-23 August 2014.
I give permission for my child to travel in service transport (including aircraft) engaged by, or on behalf of, the Ministry of Defence.
I give my permission for my child to receive hospital treatment including an operation in the event of my child being taking ill or involved in an accident.
I fully understand the reason for signing the Application to Attend Certificate.
Name: ______(Parent/Guardian)
Phone Number:
Date: ______
PARENTAL/GUARDIAN CONSENT TO UNDERGO TRAINING
Name and Initials of Cadet: / Name of Parents/Guardian:Home Address:
…………………………………………….
…………………………………………….
……………………………………………. / Telephone Number:
Daytime: ……………………………………
Evening: ……………………………………
Work: . …………………………………..
Date of birth: / Detachment:
My Son/Daughter has a special diet (eg Halal, vegetarian) YES NO
My Son/Daughter is able to take part in water sports YES NO
My Son/Daughter is able to take part in adventure training (eg Abseiling, YES NO
climbing)
My Son/Daughter is able to take part in air flights whilst at annual camp YES NO
I understand that there is no means to return home due to homesickness. This must be done at the expense and inconvenience of the Parent/ Guardian
Date: / Signature of Parent/Guardian
Relationship to cadet:
……………………………………………………………………………………………………
DETAILS OF ANY KNOWN AILMENT OR ISSUE (INCLUDING HOMESICKNESS)
………………………………………………………………………………………………………
………………………………………………………………………………………………………
DETAILS OF ANY PRESCRIBED MEDICINES TO BE TAKEN TO CAMP
………………………………………………………………………………………………………
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DETAILS OF ANY RELEVANT INFORMATION THAT MAY BE OF ASSISTANCE
………………………………………………………………………………………………………
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ALL cadets must have a parent or guardian available throughout the duration of camp should the need arise for the cadet to be sent home (for illness or any other reason). If this is not provided the cadet will NOT be able to attend annual camp.
If there is no responsible adult designated and no contact is possible after several attempts, external agencies may need to be informed to maintain the cadet’s safety in line with the Child Protection Agency.
PARENTAL/GUARDIAN CONSENT FORM – MEDICAL DETAILS
Home Address:
…………………………………………….
…………………………………………….
……………………………………………. / Telephone Number:
Daytime: ……………………………………
Evening: ……………………………………
Work: . …………………………………...
Date of birth: / Detachment:
Contact Details for duration of Camp. (This must be provided if different to home address)
…………………………………………….
…………………………………………….
……………………………………………. / Name and address of family doctor
………………………………………………
………………………………………………
………………………………………………
Telephone: ……..……………………………
As Parent/Guardian of the above named cadet I CAN CONFIRM
My son/daughter is of good health YES NO
My son/daughter is not suffering with any infectious disease YES NO
Or been in contact with any infectious diseases in the last three weeks YES NO
My son/daughter does/does not have any known allergies (i.e. Penicillin, Elastoplast)
My son/daughter does/does not suffer with Asthma
If Asthma sufferer, is any medication required? If so what …………………………………….
My son/daughter does/does not suffer with Diabetes.
If Diabetic, is medication/insulin required? If so what …………………………………………
My Son/Daughter does/does not suffer with learning difficulties (eg ADHD)
If so, what? ......
My Son/Daughter does/ does not take regular medication (eg Hayfever tablets)
If so, what? ……………………………………………………………………………………..
My Son/Daughter does/ does not have any bladder problems
My son/daughter has/has not required a doctors/hospital appointment in the EIGHT weeks prior to the start of camp. If they have please give details ………………………………………………………………………………………………………
………………………………………………………………………………………………………
I give consent for my son/daughter to receive emergency medical treatment if deemed necessary by the nursing staff YES NO
Date: / Signature of Parent/Guardian
Relationship to cadet:
NOTES
1. The Ministry of Defence cannot entertain certain risks and these must be eliminated by regulations. For example:
a. Epileptics are not allowed to undertake strenuous activities such as; rock climbing, swimming, shooting, canoeing, orienteering, expeditions in wild country etc.
b. Asthmatics, whether or not they are receiving any form of therapy, are not allowed to undertake activities involving strenuous exertion.
c. Diabetics dependent on insulin treatment may not undertake activities involving irregular meals or periods of prolonged exertion.
d. Heart problems are of such a variable nature, that they must be judged individually by the Cadet's Medical Practitioners before they attend and the GP must state in writing that he is happy for the child to attend.
2. Should any doubts exist on whether your child is fit to undertake all the activities listed on page 1, your doctor should be consulted before signing this form.
I certify that to the best of my knowledge my child is not suffering from any infectious diseases and has not been in contact with any other person with an infectious disease during the previous three weeks.
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