IC Bronze Project

First Name

Last Name

Gender

Date of Birth

Your personal SCHOOL email address

Ethnic Origin

Nationality

Nationality 2 (required if you hold Dual Citizenship)

Students Home Contact Details

Address Line 1

Address Line 2

Address Line 3

Town

County

Postcode

Contact Phone

Mobile Phone

Alternative Email

School Details

Which school are you currently attending?

Please search by School Name, School Address or School Postcode. If your school does not appear in the lookup, please select 'none'

In Case Of Emergency

Emergency contacts must be over 18 and at least one should be in the UK for the duration of the course. Please provide a separate phone number for each of your emergency contacts.

Title

First Name

Last Name

Address Line 1

Address Line 2

Address Line 3

Town

County

Postcode

Contact Phone

Mobile Phone

Relationship

Title

First Name

Last Name

Address Line 1

Address Line 2

Address Line 3

Town

County

Postcode

Contact Phone

Mobile Phone

Relationship

Medical And Dietary Information

We want to help you get the best from your Industrial Cadets Gold Project experience and need you to tell us about any special arrangements we need to make. This will not adversely affect your participating in the scheme but you must keep us up to date on your wellbeing, so that we can put in place arrangements to look after you.

Please use this space to tell us about any of the following:

Mobility issues, hearing or visual impairment

Any health or medical conditions including anxiety or eating disorders

Any other recognised or diagnosed condition for example ADHD, Asperger's Syndrome, or Autism

Allergies including food types e.g. nuts

Dietary needs such as vegetarian, no dairy, Halal, etc.

Do you have any medical information you would like to make us aware of?

NoYes

Do you have any dietary information you would like to make us aware of?

NoYes

Data Protection

Photo Consent

During participation in your chosen EDT programme, photographs/video footage may be taken of you and used by EDT or its partner organisations to promote EDT and STEM activities. Some examples of how we use images/video footage are for brochures, social media, website and fundraising resources. Images are carefully selected to portray the programmes and students positively as well as to further promote our cause.

I give consent to my photos/videos being used for the purposes stipulated above

Data Protection Act

Engineering Development Trust stores personal information you give us to allow us to administer the Scheme programme. We also use it to provide you with current and future information about our third parties' services and engineering opportunities. Should you consent, we will hold your data for the remainder of the programme delivery and two years thereafter. We will then contact you with the option to 'opt-in' to keep your details on our files for future opportunities available to you.

Parent/Guardian/Carer Declaration (not older sibling unless legally appointed as guardian)

My child/ward is under the age of data consent currently set at 16. I therefore give my consent to this application (including the use of images/video footage where such consent has been given above) and will support my child/ward in fulfilling the requirements of the above declaration.

NB, I understand that EDT is responsible exclusively for the allocation of places to our courses.

I the Parent/Guardian/Carer give my consent to the above statement

Student Details

Students Home Contact Details

School Details

In Case Of Emergency

Medical And Dietary Information

Data Protection