Whitewater Ways Individual Consent Form
Name
First Name
Last Name
Email
example@example.com
D.O.B
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Paddle UK Membership number:
Address
Street Address
Street Address Line 2
City
County
Postcode
Medical conditions, allergies or significant disabilities
Any relevant qualifications or experience
What craft are you intending to use?
kayak
SUP
Sit on top
Canoe
Are you happy for photos/ Videos to be taken?
yes
no
Phone Number
-
Area Code
Phone Number
Emergency Contact Name
First Name
Last Name
Emergency Contact Number
-
Area Code
Phone Number
If Under 18 Full Name of Legal Guardian
I confirm that I am 18years old or above. (If under 18 Signed by your legal guardian on your behalf, this is usually a parent) I understand that taking part in adventurous activities will contain some risk, Whitewater Ways and all staff will manage and limit risk wherever possible. I understand that I am solely responsible for my own actions when taking part in such activities.
*
I agree to this statement
Signature
*
Submit
Should be Empty: