Parental Consent Form

(Under 18 years of age)

    Name (Required)

    D.O.B (Required)

    Address (Required)

    Postcode (Required)

    Activities (Required)

    Location (Required)

    Arrival Date (Required)

    Departure Date (Required)

    Is your Child confident in water? (Required)

    Does your child have any medical/physical disability/illness/allergies? Does this require any medication or treatment? Are they likely to be affected by heights/exposure to cold/sun/water? (Required)

    If yes, please give brief details (these will be treated with strict confidence).

    Please provide two emergency contacts for your child, one of which should be yourself.

    Your Name (Required)

    Your Contact No. (Required)

    Your Email (Required)

    Name (Required)

    Contact No. (Required)


    READ CAREFULLY BEFORE SIGNING

    By their very nature, outdoor activities can be physically and psychologically challenging. They have inherent risks and hazards associated with them. Active applies necessary measures to ensure the safety of its participants. However, accidents do occur as a consequence. Participants should consider these risks and be aware of hazards. Clients must always adhere to Active's staff instructions. Active will not accept responsibility for loss or injury resulting from a person’s failure to adhere to safety briefings and training provided or failure to disclose information requested.

    THIS INFORMATION WILL BE TREATED WITH THE STRICTEST OF CONFIDENCE AND WILL BE DESTROYED AFTER YOUR ACTIVITY.

    Parent Signature (Required)

    Date (Required)

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