Participants Details Form

Gathering information about all participants on OCWC events

Provider
Event Name
Dates
including year

The reasons for asking for all the following information are:

  • GCC needs to know which disabled participants have taken part in the OCWC programme – and
  • Active Impact would like to be able to follow up all the participants including the non-disabled people and volunteers.

We particularly want to be able to find out what the longer term impact has been for the disabled participants and their families as well as follow everyone up to see whether they would like to be re-involved in the wider programme.

Level of assistance needed for the disabled participant to take part - this info is for use on page 2.
High / Either needs one or more adults closely assisting constantly
Or needs assistance from adult with specialist skills (eg nursing, BSL, Makaton)
Medium / Needs 1:1 assistance sometimes eg for feeding, going to the toilet, for challenging behaviour
Low / Everyone else!

Disabled participants

First and last name
Date of birth Gender / How did they pay?
Personal budget?
Own money?
Other? / Level of assistance needed (see page 1 for definitions) / School / College they attend / Name of responsible person we should contact re follow up after the event:
(delete as appropriate) / Contact tel no, email address and postal address for parent / carer /professional we should contact re follow up
DOB: M / F / Parent / Carer /Professional
Name: / Tel:
Email:
Address:
DOB: M / F / Parent / Carer /Professional
Name: / Tel:
Email:
Address:
DOB: M/ F / Parent / Carer /Professional
Name: / Tel:
Email:
Address:
DOB: M / F / Parent / Carer /Professional
Name: / Tel:
Email:
Address:
DOB: M / F / Parent / Carer /Professional
Name: / Tel:
Email:
Address:
DOB: M / F / Parent / Carer /Professional
Name: / Tel:
Email:
Address:
DOB: M / F / Parent / Carer /Professional
Name: / Tel:
Email:
Address:

Please add more rows if needed.

Non-disabled participants

Number of non disabled participants

We need to know how many non-disabled participants came on your

event for the statistics we have to give GCC.

You only need to give us the details of non-disabled participants who you would be happy to ‘share’ with other OCWC providers! That means children and young people who would be happy to be contacted by us or other providers to go on other OCWC events.

Name / Address / Parent Email address and phone number
DOB: M / F / Parent name:
Tel:
Email:
DOB: M / F / Parent name:
Tel:
Email:
DOB: M / F / Parent name:
Tel:
Email:
DOB: M / F / Parent name:
Tel:
Email:
DOB: M / F / Parent name:
Tel:
Email:
DOB: M / F / Parent name:
Tel:
Email:

Volunteers (not paid staff)

You only need to give us the details of volunteers who you would be happy to ‘share’ with other OCWC providers! That means people who would be happy to be contacted by us or other providers to help on other OCWC events.

Name / Address / Email address and phone number
Tel:
Email:
Tel:
Email:
Tel:
Email:
Tel:
Email:
Tel:
Email:

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