Participant Information Form

Participant Information form

Each participant is required to submit a Participant Information Form.

Full Name *

Street Address *

Apartment, suite, etc

City

ZIP / Postal Code

Country

Phone *

Email Address *

Date of Birth *

Date of Activity *

Activity taking part in *

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship *

Do you have any medical conditions or injuries which your instructor should be aware of.

If you answered yes to the previous question, please provide details.

Will this affect your ability to participate in the activity?

Are you currently on any medication?

If you answered yes to the previous question, please provide details.

Do you have any allergies?Please list any allergies or intolerances including severity of reactions.

Acknowledgement *I understand that failure to disclose food allergies or intolerances may increase the risk of allergic reactions, and accept responsibility for providing accurate and complete information.I accept and understand.

Acknowledgement *I understand that mountaineering, water sports and land based activities are activities which carry an element of risk that is beyond our control. We have a great safety record, and we will help you be part of the decision making process and understand the risks involved throughout the day. Regardless, due to the environments were in, an element of risk will always remain.I accept and understand.

Marketing and Social Media *During activities, instructors may take photographs for your personal use and future marketing purposes. Do you consent to having your photo taken?YesNo