Youth break with albinism fellowship

Date: 3 to 6 April 2018 
Venue: Caldecotte Xperience, Milton Keynes
Age: 14 to 17 years
Cost: £40 (includes all activities and meals, except one night when we will eat at a nearby pub)
Closing Date: 20 February 2018

VICTA is excited to be teaming up with the Albinism Fellowship, a sociable organisation providing information, advice and support for people with albinism and their families. Together, we are running a youth break in April for young people aged 14 to 17 years at the Caldecotte Xperience, an activity centre in Milton Keynes. The Caldecotte Xperience offers a variety of exciting adventure activities and learning experiences for young people. The break should be action packed with activities such as zorbing, canoeing, sailing, climbing, bush-craft and more.

The young people will be fully involved in the break, helping to prepare meals and staying in the outdoor yurts – a modern camping experience complete with bathrooms and electricity! 

yurts - Caldecotte Xperience

The yurts at the Caldecotte Xperience

There will be plenty of opportunities to socialise with a pizza night, down-time and a fun, varied and exciting few days. The contribution required towards this break is £40.00 and will cover main meals, accommodation and all of the activities. We will be eating out one evening so spending money will be required to cover this meal.


Why apply?

  • A great opportunity to meet other young people your age with Albinism
  • Grow in confidence through challenging outdoor pursuits
  • Practice some basic cooking skills
  • Develop your teamwork skills
  • Increase your mobility and independence skills
  • Gain all of this while having a fun weekend in a supportive, encouraging environment

Who can apply?

You must be:

  • Blind or partially sighted and have Albinism
  • Aged 14-17 years old when the activity takes place
  • Willing and physically able to take part in set outdoor activities designed as a group
  • Able to maintain your own personal hygiene


To apply please complete the online application form found below. You must also download and complete a parent consent form for each young person attending. Completed consent forms can be sent by post, email or as an attachment on the form below.

Post: VICTA, 5 Douglas House, 32-34 Simpson Road, Fenny Stratford, Milton Keynes, MK1 1BA.

Email: activities@victa.org.uk. 

Download the parent consent form

 


Activity Break with the Albinism Fellowship - Application Form

Fields marked with a * are mandatory.


Note for applicants completing this form

After completion, if you have successfully submitted the form, you should receive a successful submission message. If you do not it may be because you have not completed a required field. Fields which have not been completed will then be marked with the message 'This is a required field' so you may wish to search this.

After your form has successfully gone through you will also receive notification via email. If you do not receive an email please contact the office on 01908 240 831 as there may have been a problem with your application.

If you are under 18 years of age this form must be completed and signed by a responsible adult who has permission to act upon your behalf, i.e. a parent or guardian.

Applicant Details

Contact Details


If the applicant will be under 18 years of age at the time of the activity please enter the contact details for their parent or guardian.

Emergency Contact (EC)

About You

Medical Details

Independence Skills

In order to ensure that activities are adequately staffed we need full and accurate information about all participants. Declaring any problems will not necessarily exclude you from being accepted on an activity but will enable us to put the appropriate support in place. Please note we reserve the right to refuse admission to the activity or ask a participant to leave the activity if the information given proves inaccurate or the conduct of the participant reaches an unacceptable level.

General Information

The overall theme of this activity is about having fun, but we would like you to gain confidence and develop life skills through a programme of leisure, cultural and social activities. There may be times when you are expected to be fully independent and staff / volunteers will not be overseeing you (participants usually help each other at these times) e.g. moving between workshops or to the dining room. To help us plan our activities and staffing levels please describe your ability in the following areas:

Photographs and Filming

Photographs and video footage may be taken during our activities. These will be used to create photo albums both on VICTA/Albinism Fellowship's websites and social media after the activity to share with family and friends and to promote the activity. VICTA/Albinism Fellowship may also use any photographs or video material taken during an event for the future marketing, publicity and fundraising of activities.

Once you have a place on the activity, you will be informed by email along with the other successful applicants. It is normal practice for us to CC all applicants so that you can all see who is attending and make contact if wished before the activity. If you do not wish us to share your email address with others on the email please tick the box below.

Declaration, Privacy and Parent Consent

To be signed by the applicant or if the applicant is aged under 18 by a parent or guardian.

This form has been completed accurately and I undertake to update VICTA should any of the information in this form change.

In order to ensure that activities are adequately staffed we need full and accurate information about all participants. Declaring any problems will not necessarily exclude you from being accepted on an activity but will enable us to put the appropriate support in place. Please note we reserve the right to refuse admission to the activity or to ask a participant to leave the activity if the information given proves inaccurate or the conduct of the participant reaches an unacceptable level.

a. I/the applicant agree(s) have read all the information sent, and agree to my child's participation in VICTA's activity.

b. I acknowledge the need to behave responsibly at all times and to be respectful, not only towards staff and volunteers, but also to my fellow participants. I understand that any poor behaviour on my part may result in me being asked to leave the activity (at my own cost). In addition, if I experience or witness anything that gives me cause for concern, I agree to inform a member of VICTA staff immediately.

c. I/the applicant confirm that this form has been completed accurately and have declared all the support needed. I/the applicant undertake to update VICTA's organisers should any information contained on the form or personal circumstances change.

d. In the event of an emergency/accident, I/the applicant consent(s) to emergency dental, medical or surgical treatment, which may include the use of anesthetics, as considered necessary by the medical authorities present.

By signing this form you consent to VICTA/Albinism Fellowship using the information supplied for the purpose of administering the named event. All the information will be treated in the strictest of confidence and made available only to those staff working with the participant. Contact information will be retained and used for marketing of other relevant services.

I/the applicant give(s) consent for VICTA/Albinism Fellowship to carry out the following in accordance with the Data Protection Act (1998) and to store my personal information on VICTA/Albinism Fellowship's database and/or any other suitable system.

I/the applicant agree(s) to provide any relevant additional information required, such as the applicant's CVI with the application.

Agree to payment and T&C's

Cheques must be made payable to VICTA and posted to:
VICTA Children Ltd
5 Douglas House
32-34 Simpson Road
Fenny Stratford
Milton Keynes
MK1 1BA

If you wish to pay by card over the phone please call us on 01908 240831.

PLEASE NOTE: After you click submit the form will be hidden and you should receive an on-screen successful submission message. You will also receive a confirmation email. If you do not it may be because you have not completed a required field. Fields which have not been completed will then be marked with the message 'This is a required field' so you may wish to search this.