D of E

FORM B

FORM B

Warwickshire DofE – Young person Enrolment Form 2011

GROUP / SCHOOL / UNIT | North Leamington School |

ENROLMENT DETAILS |

Are you already enrolled on eDofE (please tick as appropriate | Yes | No |

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If yes, what is your ID number | | | | | | |

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| Cost | Pleasetick | Age |

I wish to enter at BRONZE level | £29.00 | | Yrs | Months |

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| | | Min 13 yrs 6 months |

I wish to enter at SILVER I have completed Bronze level | £29.00 | | Yrs | Months |

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| | | Min 14 yrs 6 months |

I wish to enter at SILVER DIRECT level I have not completed Bronze level | £29.00 | | Yrs | Months |

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| | | Min 15 yrs |

I wish to enter at GOLD level I have completed Silver level | £35.00 | | Yrs | Months |

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| | | Min 16 yrs |

I wish to enter at GOLD DIRECT level I have not completed Bronze level | £35.00 | | Yrs | Months |

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| | | Min 16 yrs |

PLEASE COMPLETE FORM IN BLOCK CAPITALS |

Title: (please tick as appropriate) | Mr | Miss | Other |

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Date of Birth: | DAY | DAY | MONTH | MONTH | YEAR | YEAR | YEAR | YEAR |

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First Name: | | | | | | | | | | | | |

Surname: | | | | | | | | | | | | |

Email: | | | | | | | | | | | | |

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Address: | |

Postcode: | | | | | | | | | |

Telephone | | | | | | | | | | | | |

eDofE will email your username and password to the address shown above so please write legibly |

Data supplied on this form and information about DofE activities recorded in eDofE will be used by Warwickshire County Council, The DofE Charity and DofE centre to monitor and manage DofE participation and progress. All contact from Warwickshire County Council and the DofE...