Duke of Edinburgh's Award Application form 2019
By completing the application form below, you are confirming that your son/ daughter will:

- Complete the required timescale for the skill, physical and volunteering sections

- Adhere to the following deadlines
               Complete the 3 month section by Monday 24th February 2020
               Complete the 6 month section by Monday 1st June 2020
               Complete the 12 month section by November 2020
               Complete the 18 month section by May 2021

- Attend the one day expedition training as well as the practice and assessment expeditions

You are confirming that you understand the following:

- I understand that if my son/ daughter does not complete the above activities then they may be asked to leave the programme

- I understand that if my son/ daughter's attitude and behaviour fall below that which is acceptable, then they may be asked to leave the programme

- I understand that mobile phones are only to be used in emergency during the expedition and may be confiscated if used for any reason other than this

- I understand that once my child has been accepted, any monies paid are non- refundable

- I will pay the final balance before my child breaks up for the Christmas holidays

YOU WILL RECEIVE A CONFIRMATION PACK ONCE YOUR CHILD HAS BEEN ENROLLED ON THE AWARD.

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Email *
Which level of the Award are you applying for? *
Your child's surname (As you would like it shown on their certificate) *
Your child's forename (As you would like it shown on their certificate) *
Your child's tutor group *
Your child's gender *
Your child's date of birth *
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Your child's Furze Platt email address *
Your child's Furze Platt user name *
Please indicate if your child has any of the conditions below, and provide further information if necessary *
Required
If you have indicated a medical condition above, please provide further information
Is your child in receipt of free school meals? *
I consent to the above named child to be photographed for DofE activities. This may mean they appear in the DofE or school's social media accounts, websites and newsletters *
I would like to be signposted to external agencies who may be able to provide financial assistance *
Name of parent/ carer *
Email address of parent/ carer
Thank you for completing this form. Please see some useful contact details below:
Desrene Carty                           DofE Manager, Furze Platt Senior School                     dofe@furzeplatt.net

Dave Randall                             Outdoor Education & Enrichment Leader                     dofe@furzeplatt.net

Leigh Rose                                 Logistics Manager, BXM                                                 info@bxm.org

Duke of Edinburgh Award                                                                                                    www.dofe.org
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