Parental Consent Form

    Child's Name (Required)

    Email (Required)

    Address (Required)

    Date Of Birth dd/mm/yy (Required)

    Is Your Child Confident In The Water? (Required)

    Activity / Course (Required)

    Activity Date/s dd/mm/yy (Required)

    Emergency Contact (Required)

    DOES YOUR CHILD HAVE ANY MEDICAL / PHYSICAL DISABILITY / ILLNESS / ALLERGY? DOES THIS REQUIRE ANY MEDICATION OR TREATMENT? IS HE/SHE LIKELY TO BE AFFECTED BY HEIGHTS / EXPOSURE TO COLD / SUN / WATER ? YesNo

    Data Protection Statement
    Active Outdoor Pursuits take privacy seriously and will only use personal information for the purpose(s) for which you have provided it and to ensure our legal and professional obligations to provide safe outdoor adventure experiences.

    Personal information pertaining to children under 16 years will be kept on secured servers.
    Hard copies of this information is required by Active staff to ensure safe practice is maintained at all times. This information will be destroyed within 30 days of any visit.

    We will never share personal information with third parties.

    You can view our full privacy statement at the this page.
    I agree to you using my child’s information for the purposes stated

    I agreeI disagree

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