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appendix IIIRecord of Payments28www.rockleyadventure.coM 01202 677 272Pupil NameAmountDateAmountDateAmountDateAmountDateAmountDateTotal PaidPayment 1Payment 2Payment 3Payment 4Payment 4

appendix IV29www.rockleyadventure.coM 01202 677 272Consent FormName of Rockley Adventure Centre: ................................................................................................................................................................Proposed Date of Trip: From: ...................................................................To: ................................................................................................... Please complete the form and return it to ........................................................ (teacher organising trip) as soon as possible and no later than ................................................................Surname:............................................................................ Forename:............................................................................. Male/FemaleDOB: ............................................ Age: ................... Home Tel: ....................................................... Nationality: ..................................Address: ......................................................................................................................................................................................................................................................................................................................................Postcode: ........................................................Pupil's DetailsName of parent / guardian: .................................................................................................................................................................... Daytime tel: ................................................... Evening tel: ......................................................... Mobile: ............................................... Name of other contact: ............................................................................................... Relation: ........................................................... Daytime tel: ............................................ Evening tel: ............................................................. Mobile: ................................................. Contact DetailsConsent to ParticipationI wish the above named participant to be allowed to take part in the above named trip and consent to him/her taking part in all activities. I have ensured that my son/daughter is willing to participate in all aspects of the trip. In the event of an emergency and the School or Rockley Adventure being unable to contact me, I give permission for any medical treatment deemed necessary to ensure the well being of the above named to take place.Payment ScheduleI enclose £50.00 as 1st deposit payment for the trip. I agree to pay the second deposit of £60.00 by 1st February 2010 and the balance by 2 months before the date of departure.CancellationI understand that deposits and monies paid are non-refundable, unless the reason for cancellation is covered by the insurance policy.Terms and ConditionsI have read and agree to the Terms and Conditions for the above trip.Parent/Guardian signature: .......................................................................................................... Date: ........................................................... Behaviour and ConductI have read, together with the above named participant and we agree to the Behaviour and Conduct guidelines for the above trip and understand the consequences of breaching these guidelines.Pupil signature: ................................................ Parent/Guardian signature: ...................................................... Date: ....................................