Dementia Jersey Avenue of Volancoes Trek 2025 : 15/11/2025 - 23/11/2025

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Personal Details

Please can you tick the box if you have been on a trip with us before

Title:

First Name *:

As it appears in your passport

Last name *:

As it appears in your passport

Gender *:

Shared accommodation is standard. We may contact you privately to discuss your room share options. Please use the Room Share Request field in the portal if required.

Gender description:

Date of birth *:

dd/mm/yyyy (under 18?)

Postcode *:

Address Line 1 *:

Address Line 2:

Address Line 3:

Town/City *:

County:

Country *:

State:

Mobile Phone *:

Home Phone:

Work Phone:

E-mail Address *:

Please re-type E-mail Address *:

Team name:

If you are participating in the challenge as part of a team please enter the team name here

Data Protection

Dementia Jersey will not pass on your details to any other organisation apart from Discover Adventure Ltd who will only use them for purposes of administering this event in accordance with their Privacy Policy. By submitting this form you agree to Dementia Jersey or Discover Adventure contacting you about this challenge.

Dementia Jersey would like to keep you informed about the charity; particularly about their services and other ways you can help, including opportunities to donate, volunteer or fundraise. If you would like to receive further information about us, please indicate below how you would prefer to be contacted:

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Where did you hear about this Challenge? *:

Please give more detail where possible:

How / where did you hear about the trek challenge? *:

Why did you choose Dementia Jersey to fundraise for? *:

Have you taken part in a Dementia Jersey challenge before? *:

By clicking Next you agree to Discover Adventure Ltd contacting you about this challenge.