Instructed Session Form

Instructed Session Form
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
In which sessions are you participating?*
Date of Instructed Session*

DayMonthYear
This form will remain active for 30 days for visiting climbers. If you re-visit the centre for the same session, you will not need to complete it again.

For club submissions (after-school, youth climbing, toddler, Teen) the form will remain active whilst you are a member of that club.
Participant Information
Name and Date of Birth for each participant:*
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
Do any of the participants have any medical or beahvioural conditions that may affect their safety whilst climbing, or the safety of other climbers at Rockburn? *
This includes behavioural issues that may cause them stop responding, try and leave the premises or similar situations.
If Yes to medical or behavioural conditions, please list here:
name followed by relevant information
Acceptance of Risk
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 are acknowledging that you have had enough time to read, process and understand the risks involved with your participation, and you are confirming your 'Acceptance of Risk' acknowledgement to Rockburn Ltd for the duration of your visit.
I have read and understood the following information and accept the associated risk 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 have read and understood the following information and accept the associated risk implied:*

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 have read and understood the following information and accept the associated risk implied:*

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: *

First NameLast Name
Date of Completion:*

DayMonthYear
From time-to-time Rockburn takes photos of running sessions to promote our business on social media and our website. If this occurs during your session, do we have permission to use photos containing participating persons listed on this form??*
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/
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Instructed Session Form

Course Participation Statement

Session Information

Participant Information

Acceptance of Risk

Privacy and Data Protection