ACTIVITY CONSENT FORM

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When we ask for YOUR NAME - please complete this if you are the PARTICIPANT OR if you are the PARENT of a CHILD PARTICIPANT.

If it is your CHILD or CHILDREN who are attending you will be asked to enter their names on later pages.
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Please select the NAME of the SCHOOL/GROUP you are attending
Please Select
Please Select
Wings School Notts
Glentworth Brownies/Guides
Lincoln Evangelical Church
The Meadows YR 5
The Meadows YR 6
St Georges - Sleaford (Monday 8th July)
St Georges - Ruskington
St Georges - Sleaford (Wednesday 10th July)
St Faiths, St Michaels
St Michaels
6th Scunthorpe Scouts
1st North Hykeham Guides
Skellingthorpe Scouts
2nd Lincoln Club Scouts
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Your Name* This field is required.This is your name if you are the participant or parent a participant u16
YOUR NAME
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Your EMAIL ADDRESSPlease enter an email address if you want a confirmation email on completion
EMAIL ADDRESS
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Your Child's Name (1)* This field is required.Only required if your child is the participant
CHILDS NAME
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Your Child's Name (2)This is for any second child attending
CHILDS NAME
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Your Child's Name (3)This is for any third child attending
CHILDS NAME
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Who should we contact in case of emergency?* This field is required.Please enter the NEXT OF KIN NAME details here
Next of Kin Name
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NEXT OF KIN contact number* This field is required.Please enter your emergency contact number here
Emergency contact number
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Please list any MEDICAL CONDITIONS that may affect participationIf completing for a child please state their NAME after the condition.
MEDICAL CONDITIONS
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Please list any MEDICATIONS the participant is currently takingIf completing for a child please state their NAME after the medication
Medications
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Please list any recent INJURIES that may affect participationIf completing for a child please state their NAME after the injury
RECENT INJURIES
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Please list any KNOWN ALLERGIESIf completing for a child please state their NAME after the allergy
KNOWN ALLERGIES
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Do you have any SPECIAL REQUIREMENTS that we can help you with during your stay?Please include any special needs, disabilities or religious requirements
If completing for a child please enter the NAME at the end of the requirement
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Please tick the following boxes* This field is required.
I have declared all know medical conditions
I have declared all know injuries
I have listed all medications taken
I understand that I (or my child) will be participating in water and/or land based outdoor activities and that all equipment, wet suit, buoyancy aid, helmet, instruction and safety cover will be provided
I acknowledge that I (or my child) DO NOT need to be able to swim but must be confident and comfortable in water
I acknowledge that I must bring suitable footwear to use in the water (old trainers are ideal), a towel and some swim wear to use under the wetsuit provided
I agree that I (or my child named above if completing on behalf of a child) can receive immediate care and attention from qualified FIRST AID STAFF on site and/or EMERGENCY SERVICE MEDICAL STAFF in the event of an incident requiring such treatment
I confirm I have made sure an inhalers or medications required are on site and staff are aware of there location
I confirm that no one attending site is showing signs of COVID 19 and has not knowingly been in contact with anyone with COVID 19 in the last 14 days.
I confirm that I am aware that all spectators must remain in the designated areas and not go 'water side' while the activities are running.
I confirm that I am aware (and have informed my child if applicable) that the instructors guidance must be followed at all times and that they can be excluded from activities if they ignore staff.
I acknowledge that the safety equipment provided must be worn at all times while participating.
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THIS IS THE LAST PAGE!

PLEASE READ THE FOLLOWING STATEMENT & SIGN ON THE NEXT PAGE

Acknowledgement of risk

Steven Poulton trading as ACTIVITIES AWAY and MARINE MASTERS ask that you read and sign the next page to acknowledge you have read these terms of participation prior to attending for your activity event.

SAFETY STATEMENT

There will always be some real risk involved in the activities we offer.

This residual risk is inherent in the activities and can not be totally eliminated without destroying the activity, or the reason for doing it.

However, the risk is generally confined to a similar level that a normal child involved in normal active play may experience, or a normal adult involved in normal active recreation would experience.

The overall level of risk is low.

We believe it is a tolerable risk when compared to the benefits.

However, you must decide if you also consider it tolerable.

To help you do this you will be given a full safety brief on the day of your event prior to activities commencing and individual activities will be explained to you at the relevant time.

All activities are carried out under instruction and extensive risk assessments and safety procedures are in place.

Civil and criminal law requires that we take all reasonable care of you.

We believe we do more than the law requires, but certain inherent risks may still remain which we can not remove without destroying the nature of the activity.

Our aim is to reduce risks to the lowest tolerable level consistent with the nature and ethos of the activity.

This document is not a ‘Disclaimer’ and by signing this document you will not lose ANY of the rights due to you as a participant.

The aim of this document is to inform participants (or their parents) so they can make a more informed choice about participation.

We operate a PARTICIPATION BY CHOICE policy which means that if you are unsure or not happy to participate in any or all of the activities on the day, then you will be able to forfeit your go and if the event is a team challenge or team building activity, no points will be deducted from your team.

Please read the following declaration as you will be asked to sign to say you have read it on the next page and explained the need to follwo our instructors instructions to your child -

I understand that all outdoor activities are ‘Assumed risk’ sports that carry attendant risks.

I am aware of and accept these risks and will be responsible for my own action and involvement and accept these on behalf of my child if applicable.

I will ensure I (or my child) will declare all relevant information to the instructors and will follow their directions and instruction at all times.
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Please sign to acknowledge you agree to our SAFETY STATEMENT* This field is required.
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