Instructed Session Form

Instructed Session Form
All customers attending a course or session led by an instructor provided by Rockburn Ltd, including (but not limited to) taster sessions, induction sessions, group parties and coaching sessions, are required to fill out this Instructed Session form.

Usage of Rockburn Ltd facilities is based around the British Mountaineering Council's Participation Statement. This recognises that Climbing (in any of its disciplines, including bouldering) is an activity that has an inherent risk to the participant of personal injury and death. Participants should be aware and accept these risks and be responsible for their own involvement.

Rockburn provides the facilities and arena for your enjoyment of climbing, and/or associated activities. Whilst we endeavour to take the necessary steps to minimise the risks involved in climbing, you the participant assume responsibility for your own safety, and the safety of those under your care whilst participating in climbing, or associated activities, at Rockburn Ltd.

By completing this form, you provide your 'Acceptance of Risk' acknowledgement to Rockburn Ltd for the duration of your visit.
Course Participation Statement
Course Participation Statement for Rockburn Ltd: I acknowledge and understand that by completing this form, I am entitled to attend and receive instruction within the remit of the course and use the climbing facilities under the supervision of an instructor assigned by Rockburn Ltd. I accept that the usage of the facilities is limited for the duration of the instructed session and DOES NOT entitle me/us to use the facilities after completion of the specified session, unsupervised, unless given express authorisation by Rockburn Ltd. If you have any queries regarding this statement, please call us on 01308426375 BEFORE you attend to discuss. *
Session Information
Which sessions are You/Your charges participating with: *
Date of Instructed Session *

Day Month Year
Recur this form? *
[This allows this form to be used for sessions for the next 28 days from the session date]
Participant Information
Name and Date of Birth for each participant: *
Emergency Contact Name *

First Name Last Name
Emergency Contact Number *

Area Code Phone Number
Do any of the participants have any medical conditions that may affect their safety whilst climbing, or the safety of other climbers at Rockburn? *
If Yes to medical conditions, please list here:
name followed by relevant information
Acceptance of Risk

By clicking the checkbox next to each statement, you are indicating that you have read, and have had sufficient time to understand the content of the statement.
I have read and understood the following information and accept the associated risks implied: *

I recognise that climbing at Rockburn is an activity with associated risks of injury and death. I acknowledge that I am aware of, and accept the risks associated with climbing at Rockburn Ltd. I accept that I am responsible for my personal involvement in the activity, or for the involvement of a person under 18 years of age, in my care I am aware that climbing is a strenuous physical activity. I confirm that I, or those under my care, do not suffer from any medical condition(s) that may increase the risk of an accident or injury occurring to myself, or to other participants I acknowledge there may be other climbers participating in activities at Rockburn whom are not competent climbers and accept the associated risks that they provide
By signing in the box, you are providing a digital signature to Rockburn Ltd, stating your understanding and agreement to the information laid out in this form: *

Clear
Full Name of parent/guardian/responsible person: *

Prefix First Name Last Name
Date of Completion: *

Day Month Year
Privacy and Data Protection

In line with new GDPR legislation which came into effect on 28th May 2018, find out details of how we collect and process your personal data through your use of our site by visiting https://rockburn-bridport.com/yourdata/
Should be Empty:

Instructed Session Form

Course Participation Statement

Session Information

Participant Information

Acceptance of Risk

Privacy and Data Protection