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Space Camp Residential Application Form
Space Camp (3 -7 Aug 20)
Step
1
of
2
50%
Your Details
Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
County
ZIP / Postal Code
Date of Birth
*
DD slash MM slash YYYY
Please note: you must be aged 14 or 15 on the first day of this course to attend.
Year Group
*
Year 8
Year 9
Year 10
Nationality
*
Please note: you will be required to show proof of British nationality.
Youth Organisations
How did you hear about this course?
Have you attended any previous RAF STEM residential courses?
*
Yes
No
If Yes, when and where was this course attended?
Parent/Guardian Contact Information
Landline Telephone
Mobile Telephone
*
Email Address
*
Enter Email
Confirm Email
School Contact Information
Name of School
*
School Address
*
Address Line 1
Address Line 2
City
County
ZIP / Postal Code
About You
Tell us why you want to go on this STEM residential in no more than 150 words - use your words wisely!
*
Please tell us a little bit about your hobbies and interests inside and outside school.
*
Have you any thoughts about what career you would like to follow when you are older and why?
*
Have you stayed away from home before and what did you learn from the experience?
*
List three things you will learn from this course:
*
Data Protection Act
The information contained in this document is classified as sensitive personal information and is subject to the provisions of the Data Protection Act 2018. It is necessary for such information to be retained for legal reasons. Only such data as is relevant to the individual’s attendance on the activity will be used or retained. Signing below indicates your consent for us to use and retain such data. You have the right under the Data Protection Act 1998 to request access to any personal information we hold on the individual.
Parent/Guardian Consent
*
Agree and continue
Name
*
Date
*
DD slash MM slash YYYY
Health Form
Student's Name
*
First
Last
Health & Wellbeing
Please tell us if the student has any of the following conditions. Please note that any information given on this form will not necessarily prejudice the inclusion of your child/ward at this activity. It is essential that this form is completed accurately in the interests of your child’s/ward’s safety and wellbeing. This information will be treated in confidence.
Asthma or Bronchitis
*
Yes
No
Heart Condition
*
Yes
No
Fits/Fainting or Blackout
*
Yes
No
Anxiety or Emotional Stress
*
Yes
No
Diabetes
*
Yes
No
Learning Difficulties
*
Yes
No
Severe Headaches or Migraine
*
Yes
No
Recurring back, leg or arm problems
*
Yes
No
Physical Disabilities
*
Yes
No
Any other allergies e.g. material, food, medication
*
Yes
No
Any other illness or disability
*
Yes
No
If the answer to any of the above is YES please give further details below.
Is there any further information the event team should have regarding the participant’s health and wellbeing?
Current Treatment
Is your child/ward receiving medical or surgical treatment or been given specific advice to follow in emergencies?
*
Yes
No
If Yes, please give details. Please give any information you feel may be of assistance to the staff in charge of the STEM residential week.
