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			Challenge Application Form

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Challenge application form

Please complete the form as fully as possible and return it to us no later than 31 January. We will launch the Challenge programme on 28 March.

* Required fields


Name of your organisation*		is required
Address
Primary Contact*		is required
Telephone Number*		is required
Mobile Phone
Email Address*		is required Invalid
Website
Secondary Contact*		is required
Secondary Telephone Number*		is required
Please tell us a little about your organisation* is required

Please provide details of your proposed Challenge, including any sensitivities or special needs that we may need to consider, and tell us the number of people from your organisation that will benefit from the Challenge*. is required

How will this Challenge benefit your organisation and/or the people you support?* is required

Can you offer any other assistance with the Challenge (e.g. Carers/Helpers from your organisation, materials, equipment etc.)?* is required

Supplementary Questionnaire for day trips and fun days


Can you tell us if any of those attending the trip have any special educational needs, medical needs or disabilities? (please note that Zurich staff cannot be responsible for the administration of any medicines).

Will any special transport be required:(i.e. wheelchair accessible)? If so, please detail how many wheelchair users there will be and whether they are able to transfer to a standard coach seat.

What will be the required supervision ratios on the day?

How many staff or volunteers will your organisation be able to supply to assist on the day and will any of these be trained in first aid?

Will you require our volunteers to be CRB checked? If so, are you able to arrange this for our volunteers.

Do you have a formal assessment policy or process in place? We will discuss this with you during February when we select the Challenges that are offered to staff.

In addition, it would help us if you could let us know the following:
Whether this trip can take place during a weekday or a weekend, or do you have a preference for one or the other?

Will you be able to arrange for those attending to be brought to a single collection point?

Please detail any further information that you feel we should be aware of.