Leader Application Form

Please complete in full, print, sign and return with photocopies of your certificates.

Contact Details

Complete all compulsory fields, denoted by , any form errors will be listed below and the field will be prefixed with a icon

1. Title:
   Brathay member:
2. Forename:
   Surname:
3. Address1:
   Address2:
4. Address3:
   Address4:
5. PostCode:
6. TelMob:
   TelEve:
7. TelDay:
   Email:
8. DOB:
   Occupation:

Parent or Guardian Details if Applicant is under 18 years of age:

1. Basic First Aid Certificate:
   Brathay Expedition Medicine:
2. Summer ML Training:
   Summer ML Assessment:
3. Winter ML Training:
   Winter ML Assessment:
4. Other Qualifications:

Previous Experience

Brathay Expedition (Most recent first)

1. Brathay Expedition 1:	Year:

2. Position:
   Main Leader:

3. ---

4. Brathay Expedition 2:	Year:

5. Position:
   Main Leader:

6. ---

7. Brathay Expedition 3:	Year:

8. Position:
   Main Leader:

9. Personal & Other Organisations Expeditions (Most recent first)

10. Personal/Other Org Expedition 1:	Year:

11. Position:
    Main Leader:

12. ---

13. Personal/Other Org Expedition 2:	Year:

14. Position:
    Main Leader:

15. ---

16. Personal/Other Org Expedition 3:	Year:

17. Position:
    Main Leader:

18. Other Relevant Outdoor Persuits /Fieldwork/ Leadership Experience (Most recent first)

19. Other 1:	Year:

20. Position:
    Main Leader:

21. ---

22. Other 2:	Year:

23. Position:
    Main Leader:

24. ---

25. Other 3:	Year:

26. Position:
    Main Leader:

27. State any experience additional to that above which you consider relevant: i.e. canoeing, climbing, fell walking, camping, overseas travel, particular hobbies or interests etc.

28. Any previous experience of working voluntarily with young people? (Most recent first)

29. YoungPeople 1:	Date:

30. Location:

31. ---

32. YoungPeople 2:	Date:

33. Location:

34. ---

35. YoungPeople 3:	Date:

36. Location:

37. Health

38. Are there any relevant medical or physical conditions which might affect your participation in an expedition, in a leadershipcapacity?:

Referee: Please give the names of two referees who have been
on expeditions with you (not related to you) who would be
prepared to comment independently and objectively on your capabilities

1. Referee 1

2. Title:
3. Forename:
   Surname:
4. Address1:
   Address2:
5. Address3:
   Address4:
6. PostCode:
   TelDay:
7. TelMob:
   TelEve:
8. Email:
   Occupation:

9. Referee 2

10. Title:
11. Forename:
    Surname:
12. Address1:
    Address2:
13. Address3:
    Address4:
14. PostCode:
    TelDay:
15. TelMob:
    TelEve:
16. Email:
    Occupation:

Clicking submit processses your application and prompts you to print a copy of this page, it must be signed and returned with any necessary photocopies of certificates. Further instructions will be on the printed application.

1. Submit Cancel