Name and Contact Details
Name:
Address:
Email Address:
Contact Tel:
Emergency Contact Details
Contact Name:
Contact Tel:
Course Details
Course Title:
Course Date:
Medical & Dietary
Please state any medical conditions relevant to the activities being undertaken (previous or current), inc. medication:
Certain courses may require dietary requirement details, please state any special dietary needs:
The information I have provided is accurate, and I am medically fit to undertake adventurous activities. I understand and agree that there is a risk partaking in outdoor activities, have read the terms and conditions and agree to ensure I have adequate travel/activity insurance.