Parental Consent Form

(Under 18 years of age)

    Child's Name (Required)

    D.O.B (Required)

    Address (Required)

    Postcode (Required)

    Activities (Required)

    Location (Required)

    Arrival Date (Required)

    Departure Date (Required)

    Is your Child confident in water? (Required)

    Does your child have any medical/physical disability/illness/allergies? Does this require any medication or treatment? Are they likely to be affected by heights/exposure to cold/sun/water? (Required)

    If yes, please give brief details (these will be treated with strict confidence).

    Please provide two emergency contacts for your child, one of which should be yourself.

    Your Name (Required)

    Your Contact No. (Required)

    Your Email (Required)

    Name (Required)

    Contact No. (Required)


    READ CAREFULLY BEFORE SIGNING

    Active Outdoor Pursuits Ltd accepts its responsibility to make its activities as safe as is reasonably practicable. However, adventurous activities are inherently hazardous and cannot be completely risk free, however hard we try.

    Accidents can happen without any contributory negligence from Active Outdoor Pursuits Ltd or its staff. The centre can accept no responsibility for loss or damage to personal property or for personal injury not arising as a result of its own act or default.

    I understand and accept the above statements on behalf of the named child/dependent. I declare that my child/dependent is fit for the activities undertaken and I will inform the centre before the course of any special medical conditions that might affect their safety.

    THIS INFORMATION WILL BE TREATED WITH THE STRICTEST OF CONFIDENCE AND WILL BE DESTROYED AFTER YOUR ACTIVITY.

    Parent Signature (Required)

    Date (Required)



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