Additional Family Weekend Information

Additional information for the 2022 VICTA Family Weekends

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.

If you are having difficulty with the form, please contact the office on 01908 240 831.

Applicant details

Name of VI child you applied for

First name

Last name

Contact details

Name of parent/carer

Eye condition documentation

If this is the first VICTA activity that you are applying for, please note that applicants must be registered sight impaired or severely sight impaired, or be able to provide proof that they are registerable. Any information or documents supplied must include the applicant’s name, date of birth and visual acuity.

I confirm the applicant is registered or registerable Sight Impaired or Severely Sight Impaired

Supporting documentation
If the applicant is registered, please include a copy of one of the following registration documents:
- Certificate of Visual Impairment (CVI)
- Blind Registration Card issued by local authority

If the applicant is not registered, please provide:
- a letter from an ophthalmologist confirming visual acuity.

Please note, applications cannot be processed without these documents.

Uploading documents

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. Do we have your permission to do so?

Yes

Declaration, privacy and consent

To be completed and signed by one of the named parents/guardians listed in the application above. This form has been completed accurately and I undertake to update VICTA should any of the information in this form change. In applying for this activity, if awarded a place, I confirm the following:

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

b. I acknowledge the need to/for my child 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. With current COVID-19 legislation, we may require families to show evidence of a negative test result within 48 hours of the start date of the activity. If this should change, we will keep you informed’

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.

Agreement to declaration

I agree

I do not agree

Signed (insert name)

Date

My relationship to the applicant (if applicable)

Parent

Legal guardian

Other

If 'other' please state

Agreement to payment

By checking this box you agree to pay a non-refundable contribution of £60.00 per person (or if this is your family's first VICTA family weekend an introductory price of £45 per person) (0-4 years are free) to attend this weekend. Once you have been offered a place on this activity you will then be required to make a payment of 50% of the total cost in order to secure your place. The remaining balance will be required no later than six weeks before the activity. If you are in a position to pay more than the minimum required that would be greatly appreciated.

I agree