Vous êtes sur la page 1sur 4

MALVERN COLLEGE

DEVELOPMENT PROGRAMME
College Road, Malvern,
Worcestershire,
WR14 3DF

!
Tel: 01684 5810510
Fax: 01684 581617
Email: jn@malcol.org

!
01

Sep 2015
Dear Parent,
DEVELOPMENT TRAINING 4 5 OCTOBER 2015
All Students participating in the Malvern Development Programme (MDP) will be attending a 2-day training
course at Nesscliff Training Area (NTA). NTA is located not far from the historic market town of Shrewsbury and
is an ideal location to conduct leadership training. We are very fortunate in being able to use this area and
intend to take full advantage of the opportunity. Unfortunately the additional assets we have been allocated
require their own consent forms that are attached at the end of this letter.
1.

Students will receive instruction in the following skills:

a.
b.
c.
d.
e.

2.

Climbing Tower.
Field craft (Shelter construction).
Navigation (both day and night).
Paintball lane.
Sports.

f.
g.
h.
I.
j.

Practical Leadership stance.


Rifle Range 22LR.
Trim Trail.
Obstacle course.
Student led lectures.

Basic itinerary:
a.

Sunday 4 Oct 2015


(1)
(2)
(3)
(4)

b.

0730hrs
0800hrs
1000hrs
2300hrs

Parade at St George.
Depart for NTA.
Arrive NTA and commence training.
Students bedded down.

Monday 5 Oct 2015


(1)
(2)
(3)
(4)
(5)

0630hrs
0900hrs
1700hrs
1730hrs
1930hrs

Breakfast.
Commence training.
Training complete.
Depart NTA.
Arrive Malvern College.

This is an excellent opportunity for your son /daughter to improve their outdoor skills and leadership. I should be
grateful if you could complete and sign the attached forms of consent and return them to me before the 30 Sep.
Yours sincerely,
John Nichols
MALVERN COLLEGE SAFETY COMMITTEE
Pupils name..SULAIYMAN AHMAD FAUZI.............

House.............5...............

Type to enter text

PARENTAL CONSENT FOR PUPILS TAKING PART ON


DEVELOPMENT TRAINING
I consent to my son/daughter taking part in the DEVELOPMENT TRAINING over the period 4 5 Oct 2015.
I have been made aware of the nature of the activities to be undertaken and whilst I understand that every care
will be taken, I accept that in the event of an accident or misadventure (not arising through negligence) I will not
hold the staff of Malvern College responsible. In the case of accident, misadventure or illness whilst away from
home, I consent to any medical treatment, which may be considered necessary by a qualified medical
practitioner.

Signed.......... Date .27 Sep 15,..


Print name..AHMAD FAUZI ALI..................................................
Address 1-3A, THE LOFT, JALAN PENAGA..
..BUKIT BANDARAYA......................................
59100 KUALA LUMPUR..................................
Tel no..+60 17 878 0001..................................................
In your childs interest, it is vitally important that the organising staff should know whether
he/she suffers from any illness or disability which may effect his/her participation or requires a special diet or
medication, e.g., diabetes, asthma, vertigo or allergy.
Please give details of any complaints from which your son/daughter suffers and details of any special diet or
medication, e.g., tablet, inhalers, etc., required.
..SEAFOOD OR VEGETARIAN DIET.
....
His/her National Health Service Card No ...................................................................................
He/she is a private patient under ................................................................................... Scheme

CIVILIAN USE OF ARMY OBSTACLE COURSE PHYSICAL ACTIVITY READINESS QUESTIONNAIRE


1.

Please complete the all details below.

Participants Full Name: SULAIYMAN AHMAD FAUZI

DOB:

19/11/1999

Tel: +44 7917 919588

Address: No. 5, Woodshears Road, Great Malvern WR14 3DF


Emergency contact name and telephone number:
2.

Please read the following questions and complete the declaration overleaf.

Ser

QUESTIONS RELATING TO YOUR MEDICAL HEALTH

Has your doctor ever said that you have a heart condition and that you should only do physical activity
recommended by a doctor? NO

Is your doctor currently prescribing drugs (for example water pills) for blood pressure or a heart
problem? NO

Do you ever feel pain in your chest when you do physical activity? NO

In the past month, have you had chest pain when you are not doing physical activity? NO

Do you ever feel faint or have spells of dizziness? NO

Do you suffer from shortness of breath at any time or a respiratory condition that would prevent you
from doing physical activity? NO

Do you have any joint problems (Including neck, back & hip) that could be made worse by exercise,
including jumping and landing? NO

Are you pregnant or have you given birth in the last 6 months? NO

Do you have a condition requiring medication or are you taking medication, which would prevent you
from doing physical activity? NO

3.
If you have completed this PARQ in advance of the scheduled activity and your health status changes
prior to the start of your activity it is your responsibility to inform the instructor.
4.
Your ability to undergo the activity will be monitored during the warm up which will also provide a
functional assessment of your ability to proceed onto the Obstacle Course. If the PTI determines that, based on
his/her assessment, you are not up to the required standard; you will be refused access to the Obstacle Course.
In accordance with the Data Protection Act 1998, the ministry of Defence will collect, use, protect and retain the
information on this form in connection with all matters relating to personnel administration and policies.

Declaration:
I have read and understood the Medical Health Questionnaire above and declare that:
*I / My Child (*delete as applicable) does/does not suffer from any of the conditions mentioned or any
other condition or injury that would prevent me/them from taking part in the physical activity:
Signature:
(Parent/Guardian if under 18 years of age)

Print Name: AHMAD FAUZI ALI

Date:

REVIEW
Event/Activity Title (e.g Insight Cse Name/No):______________________________________
The PARQ must be reviewed with the participant on day of activity and appropriate action taken
if there are any significant changes since originally signed.
Instructors Signature:
Date:
To be signed below by Supervising Officer:

Print Name: