Chester Hall Residential

Participant Name

First NameMiddle NameLast Name

Membership Number

The membership was texted to you when you completed the consent form online. Please add this number at the text above and if you dont have one please complete the below link and we will create one for you. https://zsdefenceacademy.co.uk/consent/

Email

example@example.com

Phone Number

Please enter a valid phone number in the format 7720636847 (you do not need to add the 0).Format: (000) 000-0000.

Residential (Indoor accommodation) weekend Dates

Do you have any medical conditions, disability, additional needs and what medication are you currently taking?

Any Food requirements:

Type any allergies you may have

Itinerary

Self catering residential and everyone will have light cleaning duties. We will all work together to make this a great experience. Sisterhood :)

The cost of £136 Per Person includes the full experience, transport, activities and staying at the residential for 2 nights.

We are offering three optional activities on Saturday afternoon for an additional cost of £17 per person: Archery, Team Building and Map Skills. If you would like to book an additional activity, please contact Zee on 07720 636847 to reserve your place.

Breakfast, Lunch, cutlery and tea/coffee is not included, please bring your own. Friday evening Chicken birynani is served and Saturday evening BBQ is served and included only in the price.

Friday 9th Oct 26

12.30pm set off - Meeting point: Littleharwood Children Centre (near the Cage), Robinson Street, Blackburn, BB1 5PE (Please do not park your car at the centre as this closes at 6pm and your car could get locked in, park on the main road. Make sure you're on time as we will not be waiting for anyone. We will setting off promptly at 12.30pm)

2.30pm Reach the residential venue

3pm - Check in and settle into rooms

4pm - Mandatory team meeting

5pm - Tea/Refreshments - Bring your own

6pm - Team building games (Optional)

7pm - Yoga and meditation (optional)

8pm - Chicken Biryani will be served

9.30pm - Chill around the Fire and story telling (optional)

10.30pm Bedtime

(Prayer time inbetween)

Saturday 10th Oct 26

8.30am - Wake up, bring your breakfast (Please bring your own plate, cup and cutlery to use as this will not be provided) and bag pack ready for a short Walk

9.30am - Start a short walk for 3-4 hours for 5 miles led by Zee

12.30pm - Arrive at base and ready for Lunch (Lunch is not provided)

2pm - 3 activities for extra £17 - 1)Archey – 2)Team building – 3)Map skills - please confirm if you wish to attend when booking this residential

5pm - Tea/Refreshments - bring your own

6pm - Yoga session (optional)

7.30pm - BBQ Food will be served

9pm - Girl's pampering session - Face masks, Masage etc (optional)

10pm - wellbeing session and story telling (Optional)

11pm - Bedtime

(prayers in between)

BBQ SAT 10th Oct 26

Sunday 11th Oct 26

8am - Wake up and prepare your own breakfast (Please bring your own plate, cup and cutlery to use as this will not be provided)

9am - Pack items away and clean the building - Please bring your lugage to the main door

10am - Transport will arrive

12pm - Return back to blackburn drop off point Littleharwood Children Centre, Robinson Street, Blackburn, BB1 5PE

(prayers inbetween)

Chester- Please tick the activities you wish to participate in:

BED PLAN - All rooms have an En -Suite :)

Please add emergency name, relationship and contact number. (We have no reception at the venue and only access to emergency services. We will contact upon having an emergency)

I, undersigned, agree with the following statements:

I am giving my consent in case of an emergency, and in the event I cannot be reached, medical provider can secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication. Medical providers are authorized to disclose protected health information to the adult in charge and/or any physician or health care provider involved in providing medical care to the participant.With appreciation of the dangers and risks associated with programs and activities including preparations for and transportation to and from the activity, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death or loss that may arise against the organization, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with any program activity.

Name

First NameLast Name

Date

Signature

Individual Kit list (please bring a small Duffell bag and no suitcase allowed)

x2 breakfast (Sat & Sun)

x2 lunch (Fri, Sat)

Wear 1 pair warm clothes on friday and bring 1 extra warm pair to trek (top, pants, fleece, x2 socks, x3 underwear)

Bladder water bag or 2 litre bottle (alternative x2 1 litre bottle for the hike)

Walking sticks

Warm down jacket

Wolly hat, gloves

Camping Chair

Hiking boots

large bathing towel

Small face towel

Yoga mat

Walking Pants

Small back pack

Waterproof jacket/pants/

Travel size toiletries

Medication/Inhaler/Hayfever tablets

Snacks

Head Torch

Night wear

Slippers/sandles for indoors

Namaz Musalla

Flask or Mug

Plastic plate & cutlery (knife, spoon, fork)

Water bottle 1 litre

Feminine hygiene products

Sun Cream

All items will need to fit into a small travel bag and no suitcases will be accepted. you will be sent back home if a suitcase is brought as we hve no space on mini bus to store.

Contact for further information

zsdefenceacademy@gmail.com

07720636847

Residential Chester Hall - Consent Form