Jack Petchey Foundation

SkyDive 2015 Application Form

Before you apply you need to know what is involved!

To celebrate our 15th Anniversary, the Jack Petchey Foundation is supporting 15 young people to undertake
a fundraising skydive for their chosen youth charity.
A Tandem Skydive is the quickest and easiest way to experience the exhilaration of being in freefall!
Strapped to a highly qualified tandem instructor you will jump from 10,000 12,000 feet falling at speeds
of around 120mph before your parachute is deployed for you to enjoy the views as you float back to the
ground.
No previous experience is necessary and it takes just one day to be trained and to make the jump!
You will need to commit to raising a minimum of 200 for a recognised registered youth charity. You will
need to attend a training day for a full briefing and for hints and tips to help with your fundraising.
The actual SkyDive will take place in Cambridge. Are you ready to apply!!!!

Eligibility Check
If you would like to apply to undertake the skydive Programme, it is important that you meet
the following requirements BEFORE you complete this application form.
Please circle
I am aged between 16 and 24 (note if aged under 18, parental consent is mandatory)
There is no medical reason preventing me from undertaking this SkyDive (you will have to sign
a declaration of fitness)

Yes
Yes

No
No

I am under the maximum weight allowed, which is strictly 16 stone (clothes with shoes)
I am dedicated to raise a minimum of 200 for my chosen youth charity by 13th July 2015
(if I fail I understand I will have to pay the cost of the skydive myself - 150)
If accepted I will complete and submit the BPA Membership Form and Tandem Declaration of
Fitness (If you wish to see what these say then take a look at our website at

Yes
Yes

No
No

Yes

No

Yes
Yes

No
No

Yes

No

http://www.jackpetcheyfoundation.org.uk/15th-anniversary-jump
I will attend the compulsory Team Training Day at JPF HQ on Tuesday 26th May 2015 at 11am
I am available for the whole day on Wednesday 29th July 2015 (this is the day of skydive -note
if weather prevents the jump we will need to rearrange an alternative)
I give permission to the JPF to use my photo/story/words, quotes, articles, and any other
information that I provide to be released for publication or broadcast in the media in order to
promote positive stories about young people and the work of the JPF

Please tell us about you:

Your Name:
Your Address:
Your
Your
Your
Your

Postcode:
Landline Number:
Mobile Number:
email address:

Circ: TK/PA/HC

Your Borough / District:

Date of birth:
Age on 29th July 2015:

February 2015

Appx SD001

Education/Occupation:
e.g. are you at Secondary School, College,
University, Employed, Unemployed & Job
Seeking, Volunteering, Other

How did you hear about the

SkyDive 15?
Application Questions
1. What involvement have you had with the Jack Petchey Foundation?

2. What YOUTH charity would you like to raise the minimum 200 for? (Please note they
must be a recognized, registered or properly constituted charity working with young
people).
Name of charity:
Contact details for charity:

3. Why do you want to support this charity?

4. How do you plan to raise the required amount?

(Please note that the more detail you provide, the

stronger your application will be)

7. Declaration & Signatures

I confirm that the details given in this application are correct.
Applicants Signature
Date:
PLEASE NOTE if you are under18 you must get permission from a parent/guardian to participate
I have read the details of SkyDive 15 and agree for my son/daughter/ward to participate on the SkyDive 15
programme. I confirm that I will support them in raising a minimum of 200 for their chosen charity

Parent/Guardians Name
Parent/Guardians Signature
Parent/ Guardians Contact number
Send your application to:

APPLICATION DEADLINE: 20TH APRIL 2015

FAO Chris Booty, The Jack Petchey Foundation, Exchange House, 13-14 Clements Court,
Clements Lane, Ilford, Essex, IG1 2QY or email to cbooty@petchey.co.uk

Circ: TK/PA/HC

February 2015

Appx SD001