In order to provide you with the best possible holiday at Pioneer One Camp, it is important that the organisers know as much about your condition or disability as possible, so we know how much help and support you will need.
Please answer all questions in all sections as fully as you can, and then print the completed form using your browser's own [Print] option. If you need any help with completing any part of this form please contact the Camp Leader (details below) by e-mail or telephone:
E-mail to: Gillian_pioneer1@hotmail.co.uk, or
Telephone : Landline: 01249 464803 / Mobile: 07817 589387
Section 1a - Personal Details:
Section 1b - Next Of Kin Details:
Section 2 - Personal Requirements:
The answers to the questions in this section will need to be shared with your helper(s).
Please select the options that best match your requirements:
Section 3 - Doctor and Medical Details;
If you wish to discuss any aspect of your disability or support needs with the Camp Leader before you apply, please feel free to make contact by telephone or email as above.
Is there any other medical information you would like us to know?
Please list all medications that are used on a daily basis and at what time they are to be administered ( all medication is administered by our camp nurse and all medication must be handed over to her on arrival)
Section 4 - Miscellaneous Details;
If there is anything else you can tell us about yourself that will help us make your holiday more enjoyable, please tell us below:
I the undersigned, agree that simple treatments may be carried out by the P1 Camp Designated Nurse, and that further medical assistance where required be gained at their discretion.