North Coast Explorer Voyage 14-17 yrs - L237 - 14 - 17 Year Olds

Dates: 10-07-2023 to 14-07-2023
Route: Derry - Belfast
Vessel: Leader
Trainee Capacity: 12
Fee: €250

Application Form

You must be over 18 to complete this application. If the Trainee is under the age of 18, this form must be completed by a parent/guardian. Please tick box to confirm you are over 18. If this application is completed by an under 18, your application and any monies paid may be forfeit.

Please tick box to confirm you are over 18.

Is this application for yourself

Is this application for a minor

First Name as appears on Passport *

Last Name as appears on Passport *

Primary Email address for all correspondence *

Nationality *

Place of Birth *

Address *

County of Residence *

Enter your eircode without any spaces *

Country Calling Code *

Mobile Number *

Home Number

Date of Birth *

Gender * This information is used for the allocation of sleeping accommodation

T-Shirt Size *

Passport Number *

Passport Issue Date *

Passport Expiry Date *

Level of Spoken English *

Where did you hear about Sail Training Ireland?**

What Bursary Scheme are you applying for? *

Why do you require a bursary? How are you going to raise the remainder of the voyage fee? *

Why do you want to take part in a Sail Training Voyage?

Nominating Organisation / Individual *

Nominating Organisation Email *

Nominating Organisation Contact Phone *

Emergency Contact 1 Name *

Emergency Contact 1 Email *

Emergency Contact 1 Relationship *

Emergency Contact 1 Phone *

Emergency Contact 2 Name *

Emergency Contact 2 Email *

Emergency Contact 2 Relationship *

Emergency Contact 2 Phone *

If there are any medical, behavioural or other details that are important for us to be aware of in terms of your safe participation in a voyage. It is your responsibility AND that of your parent/guardian/nominating organisation to declare this information to us. We will do our utmost to identify a ship that can accommodate your needs. Please DO NOT leave medical section blank where there are no medical issues please put N/A NOTE: Past or current medical conditions, set out below, will not necessarily preclude a trainee from being accepted for a voyage - but in the interests of safety, we MUST be aware of all conditions.

Medical History - Please mark the appropriate boxes. If the trainee has / had any of the following *

None of the below

Learning disability including Autism, Asperger's or Dyspraxia

Epilepsy, fits, fainting, black-outs, or loss of consciousness

Wheelchair user

Physical Disability

Add, ADHD, ODD

Hearing impaired

Visually impaired

Diabetes

Allergies, including allergies to medication

Regular use of medication / drugs

Heart condition

AIDS / HIV

Hepatitis

Asthma / Bronchitis

Any serious illness

Any serious operation

Travel sickness

Mental Health issues

In Recovery

Anxiety/Depression or Social Disorder

Other

Please provide further details:

Medical History - Please state any other condition we must be aware of

Are you currently taking any medication? *

If so please specify: *

Do you have any food allergies or other dietary requirements? please specify: *

Email Marketing Policy

Sail Training Ireland (STIRL) may, from time to time, send email messages to the Applicant (or to Applicant’s listed Next of Kin if under 18) containing special promotions and other marketing subject to the Applicant's permission. The Applicant consents to receiving our email messages during the sign in or subscription process, meaning they may receive future email services, newsletters, special promotions or other marketing materials ("Email Programmes") as a customer of STIRL. We reserve the right to use a third-party email relationship service to deliver these Email Programmes. The Applicant agrees that STIRL shall not be responsible or liable for any loss or damage of any sort incurred as the result of any such dealings. All Email Programmes will contain an “Unsubscribe” link which the recipient may use at any time to be removed from our mailing lists. The Applicant may also unsubscribe from future Email Programmes at any time by sending an email to Info@sailtrainingireland.com with “Unsubscribe” as the email subject.

Please tick this checkbox to indicate you understand

Medical Consent

I give permission to the organisers of activities during my voyage to administer any relevant treatment or medication to the above-named participant when or if necessary.

In an emergency situation I authorise the organisers to take the above named to hospital and give my full permission for any treatment required to be carried out in accordance with the diagnosis given by a medical professional.

I agree:

Date:

Full Name:

1. Accept that there are risks associated with a sailing voyage and in order to minimise those risks I undertake to follow the rules and guidelines as directed by the professional crew and youth mentors on board.

2. I will not possess, transport, or consume, or be under the influence of illegal drugs at any time during the voyage or in the travel to and from the voyage.

3. I accept that it is illegal to consume alcohol under the legal age limit (18) and in doing so will affect my participation in this voyage.

4. I give permission to the organisers of activities during the voyage to administer any relevant treatment or medication to the above-named participant when or if necessary.

5. In an emergency situation I authorise the organisers to take me to hospital and give my full permission for any treatment required to be carried out in accordance with the diagnosis given by a medical professional.

6. I understand that the information contained in this form may be shared with third parties solely for the purpose of the voyage.

7. Photographs taken on voyages may be used for the purpose of promoting Sail Training Ireland. Yes No

Parental Consent Form for Parents/ Guardians of Young Persons Participating in Sail Training Voyages

Please Note:

Sail Training Ireland is available for your assistance and information but does not directly operate any vessels or voyages. Sail Training Ireland acts as a referring organisation between trainees and ship operators and as an administrator for various streams of funding. Once the referral has taken place Sail Training Ireland is not responsible for the running and operation of the resulting Voyage that may take place thereafter. Responsibility for all aspects of The Voyage including safety lies solely with the vessel owner/operator and the ships master. It is important to be aware that sail training is an adventure activity in an intense environment at sea, which,by its nature, can be both mentally and physically challenging and carries with it some inherent risks. Sail Training Ireland can offer no warranty as to an individual’s suitability for the experience. If there are any medical, behavioral or other details that are important for us to be aware of in terms of your child/ward’s safe participation in The Voyage, it is your responsibility AND that of nominating organisation to declare this information to us.

Name of Trainee:

Vessel:

Name of Parent / Guardian:

Contact Phone Numbers in case of emergency:

1. Permission
As a custodial parent/guardian of the above named trainee I have given her/him my permission to participate on the above voyage.

2. Risk
I further recognise that there are inherent risks involved in crewing aboard a tall ship, travel and associated activities and I am willing to accept responsibility for those risks and any consequential injury and/or loss to my child's/ward’s person and property, except where caused exclusively by the negligence of Sail Training Ireland (hereafter referred to as S.T.IRL.) and/or its agents.

3. Medical Treatment authorisation
As the parent/guardian of the above named trainee, I authorise the appropriate medical officer, at the direction of S.T.IRL. or its agents to provide medical care to my child/ward while he/she is away from home and participating in the voyage if it is required.

4. Use of Photos
Sail Training Ireland frequently uses photos of trainees as part of social media and PR campaigns. Our child protection policy has clear guidelines around the use of photography particularly when minors are concerned. Any use of photos will be of an appropriate nature. If you have any queries concerning this please see our Child Protection Policy. I agree to the use of photography during this voyage.

5. Trainee Code of Conduct
I, as a participant in the Voyage understand my responsibilities to Sail Training Ireland. I will not possess, transport or consume, or be under the influence of alcohol or illegal drugs at any time during the Voyage or in the travel to and from this event. I undertake to follow rules and guidelines as directed by S.T.IRL.

You agree to the above statements and the terms and conditions of Sail Training Ireland

Please Note: That after you complete the payment details and press the “Apply” button below, you should get a screen saying “Application Received” within a few seconds and then a confirmation email (remember to check your Spam folder).
If you do not see this screen then please ring us on 01 845 4773 during office hours.

The confirmation email will go to the first email address supplied, Please check your spam filters if you don't receive the email.