2024 Reach Activity Week Registration Form

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PLEASE NOTE THAT THIS EVENT IS NOW FULLY BOOKED. HOWEVER IF YOU WOULD LIKE TO BE PLACED ON THE RESERVE LIST. PLEASE COMPLETE THE FORM BELOW.

Reach Child Details

First Name

Last Name

Address

Postcode

Date of birth

Child's age on 4th-11th August 2024 (must be between 10 & 17 on these dates)

Medical Details

Doctor's Name

Doctor's Surgery Address

Doctor's Phone Number

NHS Number

Emergency Contact Details One

First Name

Last Name

Mobile Number

Landline Number

Emergency Contact Details Two

First Name

Last Name

Mobile Number

Landline Number

Consent

I consent that in a matter of an emergency a Reach Mentor can act on our behalf until I or another of the emergency contacts named on this form arrive.

YesNo

Do you give permission for this registration form to be shared with medical/emergency services professionals?

YesNo

Coach Travel

If possible, if would be great if you could bring your young person and pick them back up . However if this not plausible please let us know. I/we would like our child to be included in coach travel arrangements. These will be confirmed closer to the time

Yes please include me in coach travelNo, I will make own arrangements

Reach Activity Week T-shirt

This year 2024 RAW t-shirts are available, these must be pre-ordered and paid for with the deposit .

T-shirt Size

Contribution

Please indicate the amount you wish to contribute. Early Bird rate is £350-£650 (Pay what you can afford)

The actual cost is to £650+ & we are most grateful to those families who are able to contribute nearer to the full amount. If your child would like to go to RAW but the minimum £350 contribution is too much for you this year, please get in touch with the Reach Team at reach@reach.org.uk & we will discuss what we can do to help subsidise the place further.

How much would you be able to contribute?

Booking Deposit & T-shirt

Your child's place will be confirmed on receipt of a minimum deposit of £50 and payment for the t-shirt must be made now.

Payments can be made via the options below, please tick how you will proceed;

1. Click donate now on the website and pay by credit card, using reference RAW 24/surname.
https://www.paypal.com/donate/?hosted_button_id=PD6ZV65Z746N2

(This is our preferred method of payment as it streamlines into our systems best).

2. BACS payment to Reach Charity Ltd please use the reference RAW 24/surname, to sort code 40-52-40, account no. 00028547

3. Made in Instalments. Please contact Head Office to arrange at Reach@Reach.org.uk.

An invoice will be sent directly to you by email before this date but should you wish to pay earlier please contact head office via email at reach@reach.org.uk.

Please indicate how you wish to pay (details above)

Can we gift aid on your RAW Contribution?

YesNo

Submit Booking

We are at the end of the phone/email and always happy to answer questions.

If you need to cancel your child's place please note that it is our policy to offer a full refund (minus the non-refundable deposit), up to 30 days before departure. If you are cancelling within the final 30 days, we are happy to refund only if we are able to fill the place with another child, if not we cannot offer a refund even in part.

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Contact Information