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The Boys’ Brigade
Northern Ireland Headquarters
Newport, 117 Culcavey Road, Hillsborough, Co. Down, BT26 6HH
Tel: 028 926 88 444 Email: [email protected]
QUEEN’S BADGE RESIDENTIAL COURSES 2014/15
Cost
£65.00 (Cheque payable to NIHQ)
Dates and Venues
13th - 15th February 2015 (Rathmore House)
27th February - 1st March 2015 (Rathmore House)
13th - 15th March 2015 (Rathmore House)
27th - 29th March 2015 (Rathmore House)
24th - 26th April 2015 (Rathmore House)
26th - 28th June 2015 (Rathmore House) Joint Skills/Residential
Notes
Maximum of 5 Candidates per Company per Course
You must participate fully in a Completion Residential:
(a)
no earlier than the session equivalent to Year 13
(b)
not less than 12 months from the date of registration, and
(c)
not less than 6 months from the completion of Skills for
Queen’s Badge training.
Additional Notes
Registrations will only be accepted by receipt of completed record
book, form, and payment. Extra Forms may be photocopied.
Please complete relevant consent form.
If 1st choice course is fully booked at time registration is received,
Candidate will be notified that they have been allocated their 2nd
choice course
Terms and Conditions
Withdrawal, including transfer to another course, less than 8 days
prior to commencement of a course will result in the loss of 100%
of the course fee.
Withdrawal, including transfer to another course, 8-14 days prior
to commencement of a course will result in the loss of 75% of the
course fee.
Withdrawal, including transfer to another course, 15-28 days prior
to commencement of a course will result in the loss of 50% of the
course fee.
Please Enclose –
 Registration Form
 Consent Form
 Completed QB Record Book
 Course Fee
FOR NIHQ USE:
Date received
Receipt Number
The Boys’ Brigade
Northern Ireland Headquarters
Newport, 117 Culcavey Road, Hillsborough, Co. Down, BT26 6HH
Tel: 028 926 88 444 Email: [email protected]
QUEEN’S BADGE RESIDENTIAL COURSES 2013/14
Registration Form
Course Applied for:
1st Choice:
2nd Choice:
Candidate Name
Date of Birth
/
/
Company
Address (Incl. Postcode)
Telephone
Landline
Mobile
Email Address
Date of Registration for Queen’s Badge (stamped in Record Book)
/
/
I enclose £ _______ being the appropriate fee
Signed: _______________________________ (COMPANY CAPTAIN)
Tel. No. __________________
Email Address ____________________________________
FOR NIHQ USE:
Date received
Receipt Number
The Boys’ Brigade
Northern Ireland Headquarters
Newport, 117 Culcavey Road, Hillsborough, Co. Down, BT26 6HH
Tel: 028 926 88 444 Email: [email protected]
CONSENT FORM
PART A (To be completed by Company Captain/Official)
Company/Battalion/District:
Northern Ireland District
Activity or Event:
Queen’s Badge Residential
Venue:
Rathmore House, Larne BT40 1DZ
Dates:
________________________________________________________
Officer in Charge:
N.I.D. Training & Programme Officer
Contact Telephone Number:
07727994074
It is advised that parents/guardians make a note of the above details.
PART B (To be completed by the Parent/Guardian)
Full name of member:
___________________________________________________
Date of birth: _______________________ ___________________________
PERMISSION
I give my permission for _______________________________ (child’s name) to attend and take part
in activities which may include Sporting Activities, Drill, Church Parade or Visit to Local Leisure Centre. I
understand that in the event of any illness or accident, every effort will be made to contact me, but if this
is not possible, I authorise any Leader to sign on my behalf, any written form of consent required by
medical authorities.
MEDICAL DETAILS
Name and address of young person’s Doctor: _______________________________________
_______________________ Doctor’s Telephone Number: ____________________________
National Health Service Number: __________________________
Details of medicine/diet/treatment which is being taken/followed (including any medication needed whilst at
the event/activity): ________________________________________________________________
______________________________________________________________________________
Details of known allergies/sensitivities (e.g. penicillin): _________________________________
______________________________________________________________________________
My child has/has not* been immunised against tetanus within the last five years. (*Delete as appropriate)
During the time your child will spend with us, photographs may be taken for general Boys’ Brigade purposes and
for this we need your permission. On signing this form we will assume you have given permission for your child’s
photograph to be taken unless otherwise informed.
PARENT/GUARDIAN CONTACT DETAILS (for use during the event/activity)
Address: ______________________________________________________________________
Telephone: (home) _________________________ (mobile) ____________________________
Alternative Contact (name and telephone number): ____________________________________
Signed: __________________________________ (Parent/Guardian) Date: ________________
The Boys’ Brigade is registered under the Data Protection Acts. Any parent may request a copy of relevant information
by the Company/Battalion/District
and enquiries should be directed to Brigade
Headquarters.
FOR NIHQ held
USE:
Date received
Receipt
Number