Grow Wilder with VICTA in Bristol!

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.

Confirmation of vision impairment

To qualify for this activity the lead applicant must be either registered or registerable as blind or partially sighted (sight impaired/severely sight impaired). VICTA will ask for supporting evidence post application if we have not previously received it.

To be signed by the applicant or a responsible person.
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.
e. We are aware that some children use Whatsapp to communicate with their family and friends and each family unit will have their own rules when it comes to technology at home. It is likely that your child will meet other children on a VICTA activity that they’d like to stay in touch with. While we do not encourage the use of Whatsapp before the age of 16, we do encourage connections and friendships between children. We recommend that if your child has met someone that they would like to get in touch with after the activity has taken place, please email [email protected] and we can faciliate the exchanging of personal details / telephone numbers.
f. By signing this form I 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. We may need to share your details with third-party suppliers in relation to this activity. Contact information will be retained and used for marketing of other relevant services.
g. I give consent for VICTA to carry out the following in accordance with the UK General Data Protection Regulations as supplemented by the Data Protection Act 2018 and related laws and to store my personal information on VICTA's database and/or any other suitable system.