Sign up and Pay

Activity Sign-up and Credit / Debit Card Payments

Please complete this form to sign up for activities and to make payment, where required.

Participant*

Participant Date of Birth*

Participant Postcode*

Location (where you would normally attend)* Adur Chichester Horsham

Confirmation Email address*

Choose the item or event (use the location where the event is being hosted)*

Contact details for the duration of the activity

Contact Name*

Relationship to participant*

Contact Email*

Contact Phone No*

Alternative contact no*

GP, Surgery and medical information

* over 18s can certify in their own right

NHS number*

GP name and Surgery address*

GP/Surgery Phone number*

Details of any medical condition from which I / my child suffers or any additional information of which you would like the leaders on the trip to be aware. Please also give details of any medication you/your child should take and the dosage/frequency.

Please repeat any medical information you have already provided for other activities. Please also note any conditions/treatments that have been notified earlier and discontinued.

Medical conditions - type None if none (2000 chars left)*

Additional information (2000 chars left)*

You may pay your DofE Registration costs in many ways:

• We use Paypal as our credit/debit card handler
• We would prefer you use credit/debit cards in order to keep our transaction costs down, and give you an email receipt.
• Use the "Pay Now" at the bottom of the page to pay by credit/debit card.

Alternatively, you may pay by other means:
New Bank security procedures will require you to know the payee details of the account. These are:
Account Name: OPEN DOFE IN WEST SUSSEX (NO.1169592)

• By Bank Transfer, to Sort Code: 09-01-29 Account No: 06806956
Please use the Location (ADU, CHI, HOR), the level (G- Gold, S-Silver, B-Bronze), and Participant surname as the reference,
e.g. HOR-S-SMITH
• By cheque, payable to "OPEN D OF E IN WEST SUSSEX (No. 1169592)". Please put the same reference
on the back of the cheque.
• Please indicate how you expect to pay at the bottom of the page.

Some financial assistance may be available. Please email the Treasurer in confidence for more details.
In case of any queries or difficulty, please contact us at one of the locations as below:

Adur (Shoreham)		adur@opendofe.org
Chichester		chichester@opendofe.org
Horsham		horsham@opendofe.org

Please continue below to pay for Registration or Activities

Pay online or pay by BACS, Cheque or cash* Pay now by Paypal Signup now and pay later

Paypal commission

I agree to donate Paypal commission charges

Total payment due

Anticipated Payment Method* BACS Cheque Cash Free

hidAdmin

Consent declaration

I/my son/daughter, as appropriate, , wish(es) to take part in the ODECS activity and having read the programme, agree to my/his/her participation in all activities described and to be given First Aid or urgent medical treatment during any training event or expedition.

I fully understand that it is expected that I/myson/daughter will attend the activity on the dates shown.

I have ensured that I/my son/daughter understands that it is important for my/his/her safety and for the safety of the group that any rules and any instructions given by the volunteers are to be obeyed.

Open DofE Centres in West Sussex (ODECS) expects that participants will treat the centre and volunteers with respect. as we do with the participants who attend the Duke of Edinburgh's Award sessions.

It is not up to the ODECS volunteers who have trained the participants to assess the expedition section of the Award. Each expedition has an independent assessor, who has not been involved in their training. The assessor will decide if you/your son/daughter has met the required standards to pass the expedition section of their Award.

I understand that, while the ODECS volunteers and helpers in charge of the party will take all reasonable care of the participants and, unless they are negligent, they cannot be held responsible for any loss, damage or injury suffered by the participants arising during or out of the activity, including journeys to and from the venue.

I /my son/daughter :

do not have/will not attend if I have a high temperature.
do not have/will not attend if I have a new, continuous cough.
do not have/will not attend if I have loss or change to my sense of smell or taste.
will not attend if I/son/daughter are having to self-isolate due to coming into contact with someone with COVID-19 symptoms
will not attend if someone from my/our household has COVID-19 symptoms or is having to self-isolate.
will not attend if I/he/she has had a positive test in the 10 days prior to the activity.

I understand contact details provided will be passed to NHS track & trace if any attendee on the activity has a positive test within 21 days of the end of the activity.

I understand that there are levels of risk of contracting COVID-19 by attending this activity, and that Open DofE Centres in West Sussex have taken appropriate steps to assess and manage these risks.

I, the named Parent or Carer, or Participant if over 18, understand that by clicking the "I agree" box, I give consent for the participant to take part in the activity specified &/or I agree to purchase the products or services selected.

Parent or Carer First Name*

Parent or Carer Last Name*

I agree*

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