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Register your interest for Castaway

Castaway register your interest form 2023 
 

About you

Your privacy and information sharing

The Countryside Alliance Foundation will not share your medical information with any outside entities. In the event of an emergency during a Castaway event we may provide emergency care givers with details you have provided us with below, where it is deemed beneficial to your care.

To achieve a positive experience for all participants individual needs will be carefully assessed. Further information may be requested if required prior to confirming suitability to attend the Castaway programme.

If you wish to review our privacy policies, please visit our website.

You can withdraw your consent at any time by contacting info@ca-foundation.org

About your cancer

Have you had surgey related to your cancer?
Have you had chemotherapy?
Have you had radiotherapy?
Have you had other treatments related to your cancer?

About your health and support needs

Please could you share with us some information on your health and support needs, including if you suffer from any of the following conditions?

If ‘yes’ please provide details of any treatment(s) or medication(s) you take for this.

Allergies
Asthma
Depression / Anxiety
Dietry Requirements
Epilepsy
Heart disease
High blood pressure
Issues with balance / mobility
Lymphoedema
Osteoporosis
Stroke
Diabetes

Your safety and liability

I acknowledge responsibility to bring adequate supplies of any medications I take to the event and understand all medications will need to be self-administered.

I acknowledge that, as with any physical activity, performing activities during the event may have a low risk of injury to myself or to others; I assume liability for any injury I may incur or cause.

Participant confirmation

I confirm that I am completing this application on behalf of myself and not for another individual. 

Photo release

On the day we may take photos for The Countryside Alliance Foundation to publish in publications and communications related to the charity. This material may also appear on the charity web page, and social media sites. I consent to the use of photos taken at the Castaway event to be used for these purposes. ​

Subscribe to our newsletter

Castaway would like your consent to send you our regular email newsletter, could we please send you this?

Thank you for registering your interest in our Castaway events in 2023.

 

Our team will be in touch when we have new events launching.

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