RNC youth break

Date: 11 to 14 April 2018
Venue: Royal National College for the Blind (RNC), Hereford
Age: 14 to 17 years
Cost: £40
Closing Date: 27 February 2018

VICTA and RNC are hosting a youth break in April held at the RNC campus in Hereford. The trip will combine outdoor activities with cultural and social experiences. Our group will be based at the college, a Further Education College for students with visual impairments, and will travel to nearby activity centre, Oaker Wood Leisure for our outdoor adventure day.

This promises to be a fun and busy few days – a chance to try new things and gain in independence. Activities on offer at Oaker Wood include high ropes tree trekking and zip wire so we are sure to have an adrenaline fuelled day there!

We will also enjoy a social evening with bowling and pizza and plan to spend a day taking in some of Hereford’s historical and cultural points of interest. The break will be an ideal setting to meet other young people of a similar age group and share experiences.

The contribution required towards this break is £40.00 and will cover accommodation, all of the organised activities and main meals.


Why apply?

  • A great opportunity to meet other visually impaired young people your age
  • Grow in confidence through challenging outdoor pursuits
  • 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:

  • Registered or registrable blind or partially sighted
  • Aged 14 to 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 or email to activities@victa.org.uk.

Download a Parent Consent Form

RNC Youth Break 2018 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 our website and on social media after the activity to share with family and friends and to promote the activity. VICTA 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 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 to carry out the following in accordance with the Data Protection Act (1998) and to store my personal information on VICTA'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.