Full name
*
Date of Birth
*
Address
*
Email
*
Contact number
*
Course
Date of course
Please list any kit you need to loan?
*
Details of any medical, physical or behavioural conditions AND any medicine or treatment being given or taken that may affect you on acitivites
*
Emergency Contact, relationship to you and their phone number
*
Is it OK for us to use photos of you on the course in our marketing?
*
YES
NO
Is it OK for you to contact you occasionally with news or offers?
YES
NO
Please tick the following boxes to confirm
*
I recognise that mountain acitivities are dangerous and can result in serious injury or death. I am aware of the risks involved in the activity that I am taking part in.
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