External Provider Application Form - Trinity Grammar School

Duke of EdinburghAPPLICATION FORMStudent NameFirst Last Level & Trip TypePlease enter the name of the participant and select the level and trip type to be undertakenAddress of participantStreet AddressAddress Line 2CityState / Province / RegionPostal / Zip CodeCountryPlease enter your sons home addressSelect YearPlease select your son's current yearDetails of the company providing the activityCompany NameFax NumberTelephone NumberEmail AddressPlease enter the contact details of the company which the proposed activity would be conductedSelect HousePlease select your sons houseSelect the Adventurous Journeys mode of travelPlease select your sons activity/mode of travel. IMPORTANT NOTE: The participant MUST complete the sameactivity for practice and qualifying. PLUS the activity must be exactly the same as what was completed in theprevious Award levels if the application is for a Participant beyond Bronze. Additional criteria would have to met if aParticipant wishes to change modes or add a mode.Start date of activity / DD / MM YYYYPlease place the start date of the activityFinishing date of activity / DD / MM YYYYPlease place the finishing date of the Activityfile:///E|/form%20v2%20Dreamweaver%203.htm[10/08/2012 11:08:15 AM]

Duke of EdinburghAccommodationPlease select the most appropriate type of accommodationStaff member in charge of the campFirstLastPlease place the name of the staff member running the campDeparture locationStreet AddressAddress Line 2CityState / Province / RegionPostal / Zip CodeCountryPlease enter the departure location for the activityDeparture time of activity : HH : MM AM AM/PMPlease enter the time of departure for the activityReturn location after activityStreet AddressAddress Line 2CityState / Province / RegionPostal / Zip CodeCountryPlease enter the return location after the activityReturn time after activity : HH MM AM AM/PMPlease enter the return time for the activityContact name of person on camp for an emergencyFirstLastPlease enter the name of the contact person on camp who can be reached if an emergency arisesContact number of person on camp for an emergency - (###) - #### ####Please enter the phone number of the contact person from the camp who could be reached during an emergencyfile:///E|/form%20v2%20Dreamweaver%203.htm[10/08/2012 11:08:15 AM]

Duke of EdinburghParent/Guardian name First LastPlease enter the name of the Parent / guardian of the participantEmail Address of Parent/GuardianPlease enter your best email address which you can be reached onContact number of Parent/Guardian - (##) - #### ####Please enter your best contact number which you can be reached onTerms and Conditionsfile:///E|/form%20v2%20Dreamweaver%203.htm[10/08/2012 11:08:15 AM]

Duke of EdinburghStudent Expectations:The participant should be aware that whilst on this camp, he will be required to exhibit exemplary conduct at all times. Thefront green section of the Record Book clearly outlines the School’s expectations of boys’ behaviour and it is theirresponsibility to adhere to these expectations to ensure the safety and enjoyment of themselves and others.Equipment Checklist:The company concerned should communicate relevant details for the proposed trip.Emergency Contact Details:In case of an emergency the Company involved can contact Mr Tom Mae on 9581 6189.Medical Details:Please provide the relevant details regarding your son to the company providing the activity.Terms of Application:In order to potentially gain approval participants must ensure that all documentation regarding the AdventurousJourney/Residential Project are submitted at least 4 weeks before the end of term for holiday based activities. If the activityis within the school term the application must be received at least 4 weeks before the commencement date. I alsounderstand that any overseas based activities must be submitted at least 1 full academic term in advance of the proposedactivity.That the participant has attended the Service Week Expedition or completed a Residential Project in Service Week unlessthere are extenuating circumstances.That all the details regarding the trip are lodged through the online record book system to the Award Coordinator (for newsystem participants) and are provided in writing through the online submission form.That Parent/Guardian consent is given for the participant to attempt this proposed Journey or Residential project with aregistered external provider.That the organisation through which this activity is being conducted is registered and accredited in this field and plannedactivity and that those supervising have appropriate qualifications in the Industry, First Aid, Police Checks etc.That the risk assessment for this activity provided to the school through the online submission system is signed and current.That the relevant details regarding the Journey or Project such as route information/plans or activity overview are provided.Acknowledge that no staff member from Trinity Grammar School will be in attendance.Acknowledge that this activity is not instigated by the school and that the Parents/Guardians are choosing for their Son tocomplete this activity under their own volition.Acknowledge that if approval is given by the school that the Award coordinator is acting on behalf of the Head Master underguidance from relevant parties in the school and that participant acceptance to this activity is for validating the legitimacy ofthe participants attempt only.It is important to note that the school has no connection to the external provider and therefore cannot provide any advice ordirection on such matters. A participant and Parents/Guardians are making an independent evaluation of the provider andthus the school or any staff member involved in the Award programme has no responsibility to the nature or outcomes ofactivities run by external providers. The documentation and correspondence with the school is to certify that the studentsattempt at the Award component fits with the Award requirements.I hereby acknowledge that the above information is correct and I understand the parameters by which my Son will becompleting this component of the Award.Parent / Guardian Signature ......................................................... Date:DD/MM/YYYYI have discussed with my Parents/Guardians the School's expectations of me while on camp and agree to abide by them.Participant Signature .........................................................Date:DD/MM/YYYYfile:///E|/form%20v2%20Dreamweaver%203.htm[10/08/2012 11:08:15 AM]