Duke of Edinburgh's Silver Award Application Form

Applicant details

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. 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.

Supporting parent/guardian

About you

Medical details

Independence skills


Please indicate your level of independence in the following areas by selecting your response and giving details if the assistance is required.

In order to ensure that activities are adequately staffed we need full and accurate information about all participants. 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. To help us plan our activities and staffing levels please describe your ability in the following areas:

Photographs and filming

Declaration, privacy and consent

To be signed by the applicant or a responsible person. This form has been completed accurately and I undertake to update VICTA should any of the information in this form change.

a. I agree to take part in VICTA's activity and have read all the information sent to me.

b. I acknowledge the need to behave responsibly at all times during the activity.

c. I confirm that this form has been completed accurately and I 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 consent to emergency medical treatment, which may include the use of anaesthetics.

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 give 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.

Agree to payment and T&C's