4cancer

GENERAL SAILING APPLICATION BOOKING FORM

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Sailing Event: ABC
Date of event: XYZ

Step 1 of 6

4 Cancer Group’s trips involve a variety of activities which require applicants to complete the following Application Form and Medical Declaration in advance which will enable us to decide what precautions are appropriate to keep you safe. We may contact you for more details in order to clarify and in rare circumstances may prohibit you from attending a trip for your own safety.
SECTION ONE - PERSONAL DETAILS
Please tick if you are applying to go on this trip as:
- (a) Someone who has had a diagnosis of cancer
- (b) Someone who supports another person with a diagnosis of cancer
Name:
First Last
Date of birth:
DD slash MM slash YYYY
Gender
- Male
- Female
- Prefer not to say
Address
Street Address Address Line 2 Town/City County Postcode Country
Your contact details
Home Phone
Work Phone
Mobile Phone
Email
Next of kin contact details
Home Phone
Work Phone
Mobile Phone
Email

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SECTION TWO - DATA PROTECTION (GDPR) REGULATIONS
On 25th May 2018, GDPR (General Data Protection Regulation) came into effect. This is an evolution of the past Data Protection Act, but the main change is that we can’t assume we have your permission to share or store any personal or sensitive data about you that you have submitted in your Booking Form.
- What is personal data? Addresses, emails, phone numbers, certificates
- What is sensitive data? Medical information
- How do we store this now? All information is held in lockable cabinets or on a password protected computer/database.
- Who do we share your information with – before leaving on a trip or sailing on a voyage, we share your name, age, sailing experience, medical information and any other relevant that you have given us with the event or sailing provider. All information shared will be treated in complete confidence and is only shared to ensure that the relevant people are aware of anything appropriate which will ensure your safety and enjoyment during the trip.
- How long do we keep this information - There is certain information we are required by law to hold (e.g., sailing providers have to hold voyage manifestos for 7 years). But there is some information we only store for a short time (booking forms are only kept for 2 years).
- What do you need to do now – below you will find a consent form which you need to sign and return. If you are under 18, your parent/guardian needs to sign on your behalf.
If you would prefer to receive this form by post, please contact the office. Also if you would like a copy of our Privacy Policy or have any queries please contact us or look on our website.
GENERAL DATA PROTECTION CONSENT
Your consent is not assumed and we require you to sign and return this form to as soon as possible. If you wish to opt out in the future, you are required to inform us. If you are under 18 this form must be signed by your parent/guardian.
Signed
Date
DD slash MM slash YYYY
Print name
If you agree
- If you agree to us using to your first name, please tick here
- If you agree to us using your photograph, please tick here
- If you are happy for us to use your quotes, please tick here
- If you are happy for us to pass personal/medical details to our providers to ensure safety on the trip or in the event of an emergency, please tick here
We do not put names to photographs without the individual’s express permission.

A copy of the full 4 Cancer Group Privacy Policy is available on our website but please ask for a paper copy if you prefer.

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Whilst 4 Cancer Group takes all possible steps to ensure the safety of all participants on our trips, the Applicant should understand that sailing or other events can be hazardous activities. Health • If you (the Applicant) are suffering from a known medical condition or allergy such as angina, asthma (other than very mild), diabetes, epilepsy, giddy spells, a heart condition, or any other condition which might suddenly incapacitate you, if you might be pregnant, or you have recently been discharged from hospital, it might be dangerous to go to sea - you MUST get your Medical Professional to complete Section Three of the application form, stating, in plain language, the medical condition and any drugs prescribed. • If you are undergoing or have recently finished treatment or are taking any prescribed drugs, you MUST get your Medical Professional to complete Section Three of the application form, stating, in plain language, the medical condition, the treatment and/or the drugs prescribed. • Your doctor should also advise you of alternative medication in case seasickness renders your regular medication ineffective. • Where appropriate you must ensure that you are carrying the correct drugs and dosage for the sailing trip, and that your doctor has advised the appropriate brand of anti-seasickness remedy to take. • If you wear spectacles or contact lenses you are advised to bring a spare pair of spectacles for the sailing trip. • If you have a disability you must consult with 4 Cancer Group before making a reservation. Personal Property • The Applicant is responsible for his/her property while on board a 4 Cancer Group trip. Any property left on board when the sailing trip is completed will not be the responsibility of either 4 Cancer Group or the Sailing Provider, and the cost of returning such property, if found, will be at the Applicant’s expense. Insurance • The Sailing Provider’s insurance covers all aspects of its activities should circumstances arise in which the Sailing Provider is found legally liable. Neither 4 Cancer Group nor the Sailing Provider is liable for Applicants’ personal effects, money, medical or other expenses during the sailing trip. 4 Cancer Group strongly advises applicants to take out appropriate insurance in respect of each sailing trip. Cancellation by the Applicant • The Applicant or Applicant’s parent/guardian should notify 4 Cancer Group by telephone if they need to cancel as soon as reasonably possible and this must be confirmed in writing. Sailing trip places are in great demand but it can take time to reallocate them. FULLY REFUNDABLE £20 cancellation deposit To confirm your place on this trip, 4 Cancer Group needs a £20 FULLY REFUNDABLE deposit for each Applicant. Please send a cheque, payable to 4 Cancer Group. This cheque will be destroyed either when the Applicant attends the trip or if the Applicant has to cancel for reasons that are unavoidable. (Please let us know if you don’t have access to a chequebook.) CONDIITIONS OF BOOKING a) Failure to disclose relevant information may forfeit your place on a trip, even at short notice. b) Applicants must be free of any known contact with an infectious disease during the six weeks prior to any trip. c) Applicants undergoing or having recently completed treatment, and/or requiring prescribed drugs, MUST get their Medical Professional to complete Section Three of the application form, stating in plain language the medical condition, the treatment and the drugs prescribed. d) Neither 4 Cancer Group nor any event organisers can accept responsibility for any consequences of an applicant failing to take medication as recommended their doctor. You are responsible for taking your own medication and this cannot be delegated to another person on the trip. e) Applicants are under the authority of the organiser at all times, e.g., the skipper during a sailing trip, and are to carry out the duties assigned to them, and comply with his/her instructions at all times. f) Applicants unable to take up their booked trip for any reason whatsoever must notify 4 Cancer Group at once. Places are in great demand but it can take time to reallocate them. g) Applicants are responsible for their own transport costs to the port of departure and return home after the sailing trip. h) Consumption and storage of alcohol on board are prohibited unless expressly authorised. i) 4 Cancer Group trips are strictly non-smoking. j) Conduct considered by the organiser or delegated party to be disruptive, contrary to good order or prejudicial to the interests or safety of applicants, or other participants, shall entitle the person behaving anti-socially to be excluded from the trip, with adequate transport facilities, in all respects at the expense of the applicant and/or parent/guardian (including the cost of any person escorting the applicant if so decided) and without liability on 4 Cancer Group or any provider to make any refund. This includes anyone found to be using or under the influence of alcohol or recreational drugs. k) If the applicant chooses to leave the trip for any reason before the end, neither 4 Cancer Group nor any provider or organiser will be liable to pay any refund of trip fees or travel expenses incurred in returning home. If 4 Cancer Group or the provider/organiser incurs costs in escorting a minor home, these costs will be passed on to the parent/guardian. l) 4 Cancer Group and its providers reserve the right to modify, curtail or cancel any trip in the event of adverse weather conditions, mechanical problems or other circumstances beyond their control, without recompense.

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Pre-Booking – Health and Wellbeing Survey
4 Cancer Group are keen to learn about the status of our beneficiary’s health and wellbeing. For us to do this, you are encouraged to complete this short survey. The survey is designed to give us a brief understanding about your thoughts on your physical and psychological health and wellbeing. You are encouraged to be as honest as possible as there are no wrong or right answers to any of the questions. On the scale-based questions, please circle the number which matches most closely with your most immediate response.
1. Do you think this trip will make a positive difference to your health and wellbeing?
- Yes
- No
Please feel free to add a comment:
2. Do you think that the trip will be a good opportunity to spend quality time together with family and/or friends?
- Yes
- No
Please feel free to add a comment:
3. On a scale of 0-10, do you feel like going on the trip will help you connect with others?
Please feel free to add a comment:
4. On a scale of 0-10, how physically active are you at the moment?
Please feel free to add a comment:
5. On a scale of 0-10, do you feel it is difficult to focus on anything but your condition or your responsibilities for supporting for someone with cancer?
Please feel free to add a comment:
6. On a scale of 0-10, how confident are you at the moment in your everyday life?
Please feel free to add a comment:
7. On a scale of 0-10, do you feel like this trip will help you to learn new skills? (i.e, sailing skills, communication skills, people skills)
Please feel free to add a comment:
8. On a scale of 0-10, do you feel like you have become less sociable since the onset of your condition or since you started supporting for someone with cancer?
Please feel free to add a comment:
9. On a scale of 0-10, do you feel like you have become more anxious since the onset of your condition or since you started supporting for someone with cancer?
Please feel free to add a comment:

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Contact ‘Something To Look Forward To’:

Francesca Abery
Community Fundraising – Gift Donations
07920 095919
francesca@somethingtolookforwardto.org.uk

Contact ‘4Cancer Group’:

Francesca Abery
Community Fundraising – Gift Donations
07920 095919
francesca@somethingtolookforwardto.org.uk

GENERAL SAILING APPLICATION BOOKING FORM

Sailing Event: ABC
Date of event: XYZ

Step 1 of 6

SECTION ONE - PERSONAL DETAILS

Your contact details

Next of kin contact details

SECTION TWO - DATA PROTECTION (GDPR) REGULATIONS

GENERAL DATA PROTECTION CONSENT

SECTION THREE - TREATMENT AND MEDICAL INFORMATION

Equal Opportunities and Diversity Monitoring

Pre-Booking – Health and Wellbeing Survey

Contact ‘Something To Look Forward To’:

Contact ‘4Cancer Group’:

GENERAL SAILING APPLICATION BOOKING FORM

Sailing Event: ABC Date of event: XYZ

Step 1 of 6

SECTION ONE - PERSONAL DETAILS

Your contact details

Next of kin contact details

SECTION TWO - DATA PROTECTION (GDPR) REGULATIONS

GENERAL DATA PROTECTION CONSENT

SECTION THREE - TREATMENT AND MEDICAL INFORMATION

Equal Opportunities and Diversity Monitoring

Pre-Booking – Health and Wellbeing Survey

Contact ‘Something To Look Forward To’:

Contact ‘4Cancer Group’:

Sailing Event: ABC
Date of event: XYZ