Leader Application Form | Global Action

School(Required)

Name(Required)

Title Given Name(s) as shown on Passport Surname as shown on Passport

Date of birth(Required)

Correspondence Email(Required)

Passport Details

Passport Number(Required)

Passport

Accepted file types: pdf, jpg, jpeg, png, gif, Max. file size: 4 MB.

Please attach a copy of your passport page. This information is entered into your airline reservation on your behalf. Please note, your Passport must have a minimum of six months' validity from the final day of the trip. If you renew your Passport in the lead up to the expedition, please provide a copy via email.

Contact details

Mobile(Required)

Home Tel.

Work Tel.

Correspondence Address(Required)

House No./Name Address Line 2 Town County Post Code

Next of Kin

Name(Required)

Title First Surname

Relationship to School Leader(Required)

Emergency contact Tel.

Past Medical History

It is a condition of booking with Global Action Limited that you must disclose to us in writing any physical or mental condition for which you are currently taking prescribed medication, or if you have visited a medical practitioner in the past 12 months. Your failure to do so may result in your trip being cancelled without refund.

Please ensure you comply with Campbell Irvine’s medical warranty and disclose ALL DEFINED pre-existing medical conditions to ensure you have full travel insurance protection. For full details of definitions, and how to disclose a condition to the insurers, please see pages 8-9 of the full Policy Document. Your failure to disclose a defined pre-existing medical condition may result in a claim being reduced or declined.

Please note that the School and Global Action Limited reserve the right to request a report from your General or other Medical Practitioner on your suitability for the above expedition.

Condition

Please indicate if you have ever had, or continue to have any of the following medical conditions.

Respiratory illness such as asthma

Diabetes

Epilepsy or fits

Gastro-intestinal problems, including food intolerances

Radiotherapy, Chemotherapy, Immunosuppression or steroid treatment

Mental Health problems e.g. depression, anxiety, deliberate self-harm or eating disorders

Surgical operations

Admissions to hospital

Any other significant medical history not yet mentioned

If you have ticked any of the above, please provide details here

Please give details of any prescribed medication you are taking, including inhalers, the pill, skin cream, or any occasional medication

Please give details of any allergies, including penicillin, asthma, eczema, hay fever, or food allergies

Global Action will make every effort to inform airlines and ground partners of all declared allergies and make arrangements accordingly, however we cannot guarantee that all foods will be 100% allergen free.

Do you have any dietary requirements?(Required)

Yes

Please give details

Please indicate your weight in KG(Required)

Please enter a number from 1 to 200.

Please indicate your height in Metres(Required)

Does the applicant have any objections to immunisations?(Required)

Yes

Water Confidence

Global Action needs to know the ability and confidence of participants in/on water, where there are any activities that involve water. Participants wishing to take part in any water activities with Global Action must complete the following declaration. Please remember: the applicant is the one at risk if a false declaration is made.

I am confident in water

I can tread water for 30 seconds

I can swim 25-meters unaided

I can swim 10 lengths of a 25-meter pool comfortably

School Leader Terms and Conditions

As a School Leader, you will defer to the Global Action Trip Leader in all matters. You will however be responsible for the following key areas:

Being physically fit for this trip. Please see the Leaders’ Handbook for fitness requirements
Accompanying ill or injured Team Members on any visits to medical facilities or if an activity has to be missed through medical or other considerations
Providing pastoral care to all students and consulting the Leader on any management requirements for them
Managing the behaviour and conduct of the students in accordance to the Trip and School rules
In partnership with the Leader, ensuring the School Policy (including Child Protection Policies of Global Action and the School) are upheld and any incidents related to these are dealt with accordingly.

NB. Further responsibilities are outlined in the Leaders Handbook. Please refer to the trip quotation sheet at the back of the itinerary for details of included and excluded arrangements. You will be responsible for any excluded costs as outlined in this trip quotation.

Confirmation and acceptance of conditions(Required)

I have the full approval from the school to take part in the trip.

I have read and accept the terms and conditions

Image Consent

Granting full rights to Global Action Ltd to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for marketing and publicity purposes. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, and press releases.

Accept image consent(Required)

Yes

Travel Insurance

The school has agreed to use our specialist adventure travel insurance with Campbell Irvine. This includes 24-hour medical emergency assistance and repatriation. This travel insurance and cover is included in the price of the trip.

Declaration

To my knowledge, the details on this form are true and accurate.

I have read, understood and accept the School Leader Terms and Conditions and the relevant booking conditions online, at www.global-action.co.uk
I confirm that I am of good mental and physical health and able to complete the outline itinerary given, including all activities therein.
I certify that I have read and understood the information and questions in each box in the Medical Declaration section above and will ensure ALL pre-existing medical conditions are declared to Global Action and the travel insurance provider to ensure I have full travel insurance protection.
I agree to inform Global Action that if there is any change in my health, medication, allergies, or special dietary information, as soon as possible.
I understand that all information on this form will be shared with Global Action’s Medical Advisor and Leadership Team (including the other school teachers and Leader) as necessary.
I authorise that the trip leader, and other School Leader, nominated by Global Action, may sign any consent forms for medical treatment for the student during the trip.
I agree to receiving medication, emergency dental, medical or surgical treatment whilst on the trip, including, but not limited to, anaesthetic and / or blood transfusion as considered necessary by the treating medical authorities.
I understand and accept that a leader’s place on a trip will only be confirmed following medical screening by the Global Action Medical Advisor.

Confirmation(Required)

I agree to Global Action processing the information within this application form in accordance with the General Data Protection Regulation (GDPR) Please tick the box to confirm

School Leader Form