Please indicate by ticking the week you are available to volunteer: 1

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Kirklees Canal & Conservation Camps Residential Project 2015
Dear Award Participant
To achieve your Gold Award, you need to complete an extra section – the Residential. This involves
spending 5 days and 4 nights away from home on a shared activity with people you’ve never met before.
Why not spend this time meeting new people and getting your hands dirty in the great outdoors doing a
variety of Conservation tasks on one of our canal & conservation camps. Our camps offer you a fantastic
chance to learn new skills such as bricklaying, painting, cutting & pruning, and restoration techniques
whilst helping to restore and maintain local woodland, wildlife habitats and the adjacent waterways.
In groups of up to 12 volunteers, you can help with essential woodland and waterways maintenance.
Volunteers will be able to take part in various tasks from vegetation clearance to learning how to help
restore a lock. Whether you are a complete beginner or have tried your hand at conservation and
restoration before, you will be guided through every task by the Canal and Conservation leader.
On an evening there will be an opportunity to relax and watch a film or take part in a range of outdoor
activities including: archery, bush craft, bouldering, cycling, rock climbing, or visit to an ice cream parlour.
The activities will be based at The DofE Marina Project Shepley Bridge Marina, Huddersfield Road, Mirfield,
WF14 9HR which is easily accessible by public transport.
The project will commence at 14:00 on Monday and you will be free to leave at around 4.30pm on Friday.
The cost of the five day residential will be £80, which includes all activities, meals and accommodation
which is camping. If you would like to book a place please send a cheque payable to Kirklees Council with
your completed booking form.
If you are ready for a 'real' challenge and happy to leave the comfort of your arm chair and get active this is
the residential project for you. During the week you will be stretched in lots of different ways and leave
with life long memories and a huge smile on your face!
Yours Sincerely
Denise Bedford
Denise Bedford MBE
Duke of Edinburgh’s Award Manager
Duke of Edinburgh’s Award Netherton Village Hall 330a-332 Meltham Road Huddersfield, HD4 7EX
julie.martin@kirklees.gov.uk Tel: 01484 222374 www.kirkleesdofe.org
Gold Residential Students Kit List
General:
Washing kit, toiletries & 2 towels, Torch with batteries, Indoor footwear (slippers or trainers) Warm sleeping bag, roll
mat/therma rest, pillow, Nightwear and underwear Plastic drinks bottle (1 litre is essential)
Sun block protection (at least factor 20-30) Change of clothing for evenings Small/medium lunch box
2 large polythene bags (strong dustbin liners)
Outdoor activity clothing: complete changes of clothing for the activities in addition to the
following items:
2 thick fleece jumpers or sweaters 3 Tee-shirts (some long sleeved if possible) 1 pair of ‘old’ trainers
2 pairs loose or track suit trousers 1 pair gloves/mittens Hat/baseball cap 3 pairs of thick socks 1 pair of shorts
N.B. Cotton stays cold when damp so on wet days and for water sports we recommend wearing fleece, nylon, wool,
or ‘thermal’ underwear next to the skin. These non-absorbent materials retain some insulation even when wet,
whereas a cotton Tee shirt or jeans can feel like you are wearing a cold, wet dishcloth!
Useful optional extras:
Do not buy these items specially; just bring them if you have them:
Safety Boots/Hiking Boots and Wellington boots, work gloves
Windproof, waterproof top
Windproof, waterproof trousers
Body warmer or padded jacket/ski jacket
Camera
Non perishable snacks
Money:
There is a small tuck-shop onsite which sells drinks & snacks. We often visit a local shop and an ice cream
parlour.
Kirklees Canal & Conservation Camps Residential Project 2015
APPLICATION FORM
Name __________________________________ Date of birth _____/_______/______
D of E Award Group (If applicable) ________________________________
Do you consider yourself to be a disabled person?
Yes/No
Please give details of any medical conditions/disabilities - e.g. diabetes, epilepsy etc. or
allergies.
Please give details of any current medical treatment, including medication.
_______________________________________________________________________
Date of last tetanus injection:
_______________________________________________________________________
Details of any special dietary requirements:
_______________________________________________________________________
We will be relying on your help and supports so please don’t over commit yourself. If you find you
are unable to attend for any reason please let the office know immediately so alternative cover
can be found. Due to the popularity of this voluntary opportunity we cannot guarantee your first
choice so please do not indicate a date when you know you are unavailable. Thank you.
Please indicate by ticking the week you are available to volunteer: 1 st, 2nd, 3rd choice
Camp 1
Monday 20 July – Friday 24 July
Camp 2
Monday 27 July - Fri day 28 July
Camp 3
Monday 3 Aug - Fri day 7 Aug
I have ensured that I understand that it is important for his/her/my safety and for the safety
of the group that any rules and instructions given by activity scheme staff are obeyed.
I undertake to inform the Leader of any changes in my health prior to the volunteering.
I am in agreement that those in charge may give permission for my son/my daughter/me
to receive medical treatment in an emergency.
Signature:
(Young Person)
Date:
Signature:
(Parent/Guardian)
Date:
Project Name
Young People Service Team
Venue
The Duke of Edinburgh’s Award Kirklees
Canal & Conservation Camp Residential Project
DofE Team
DofE Marina Project Shepley Bridge Marina
Huddersfield Road Mirfield WF14 9HR
Young Person Details *
First name :
Last name :
Date of birth :
Age :
Where did you find out about the project:
Gender :
Male
Female
Ethnicity : (Optional)
A1 Indian / A2 Pakistani / A3 Bangladeshi / A4 Asian (other)
Please circle
B1 Black African/ B2 Black Caribbean/ B3 Black Other/ C1 Chinese /
M1 Mixed Race-Asian/ M2 Mixed race-Black/ M3 Mixed Race-European/ O1
Other/ V1 Vietnamese/ W1 White UK/Irish / W2 White European/ Rather not say
Address *
Address1 :
Address2 :
County :
Postcode :
Home telephone :
Mobile telephone :
E mail Address :
Emergency Contact *
Name :
Telephone Number :
Relationship :
Additional Info
Employment/ School/College
:
Name of School / College :
Any Disabilities /
Medical Conditions:
Disability Details :
Supplementary Info
How do you get to the project
Journey Time :
Statement of Consent
1. I am aware these schemes are an open access** scheme that may include sports, recreational, arts and craft, advice
information and guidance, media, health and food related projects.
2. I confirm the details of the participant are correct.
3. I know of no medical reason why the Young Person named above should not take part in any activities.
If you do not agree to any of the following please delete as appropriate
4. I understand that this scheme may enable young people to gain accreditation and the participant wishes to be
considered for relevant Duke of Edinburgh Award program.
5. I understand during the scheme photographs and video footage will be taken and that images can be used for
promotion and evaluation.
6. I agree that information may be shared with relevant partner agencies, to secure help for young person named,
through available support and guidance.
Signature:
(Young Person)
Signature:
(Parent/Guardian) Date:
Date:
Data Protection Act 1998: The information you provide to Kirklees Metropolitan Council is necessary for project management,
development and audit, and also, when appropriate, to secure help for young persons through available support and guidance. It will be
used only for those purposes. The Young People’s Service may share it with other Council Services and Partner Agencies where this
is necessary for and consistent with the stated purposes. For the purpose of the Act the contact is The Information Access Officer,
Room 108 High Street Buildings, Huddersfield, HD1 2NQ
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