The Duke of Edinburgh’s International Award

Enrollment Form
Date:……/……./………..

Name (Block Letter):…………………………………………………………………………………………………………………………….

Address:………………………………………………………………………………………………...................................................................

Phone No:……………………………………………………………. Email:………………………………..................................................

Date of Birth:…………….…/…………….…/………….……… Age:……………………………………

Name & Address of Institution:……………………………………………………………….................................................................

………………………………………………………………………………………………………………...............................................................

I wish to participate in the Level of: Bronze Silver Gold Direct Silver Direct Gold

I am interested in the following Activities: (Select 1 activity per section)

Skills:……………………………....................................................... Service:………………………………………………………………...

Physical Recreation:………....................................................................................................................................................................

Adventurous Journey (Virtual Exploration): Not required to write anything now

Residential Project (Gold only): Not required to write anything now

Parent’s/ Guardian’s consent:

I agree that my son/ daughter/ ward……………………………………………………………………………………… (Name)
may take part in The Duke of Edinburgh’s International Award.

Parent’s/ Guardian’s Name:…………………………………………….………………Phone No:……………………………………

Signature:…………………………

Enrollment Fees:
Bronze: Tk. 2,500 (6 Months) Direct Silver: Tk. 4,000 (12 Months) Direct Gold: Tk. 5,500 (18 Months)

Payment Method: bKash- Send Money (01759071914, Personal account)