Registration Form

Registration Form
Indoor climbing activities at Port Talbot Urban Adventure Centre (PTUAC) include un-roped low-level traversing of the climbing wall, roped climbing, and the use of climbing associated training equipment.

Outdoor activities at Port Talbot Urban Adventure Centre (PTUAC) include un-roped low-level traversing, roped climbing, abseiling, bouldering, hill-walking/hiking, woodland/bush craft activities, and water-based activities such as kayaking and stand up paddle boarding.
Participation Statement
“The British Mountaineering Council recognises that climbing and mountaineering are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement.”

Supervised climbers
- Activities undertaken as a part of PTUAC's instructor-led sessions are supervised
- Supervised sessions are led by a qualified climbing instructor
- All required equipment (except climbing shoes) is supplied by PTUAC
- All equipment is checked and serviced by qualified staff
Unsupervised climbers (Indoors only)
- If you are under 18 years of age, you cannot register as an unsupervised climber. Please speak to a member of staff.
- Once you have read the Conditions of Use and Rules of the climbing centre, you must answer the questions at the end of this form by selecting either “YES” or “NO” then sign the declaration.
- Only climbers who give satisfactory answers to the questions will be registered and allowed to climb unsupervised.
Registration type*

Supervised climberUnsupervised climber
Participant's Personal Details
Name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Phone Number
Please enter a valid phone number.
Email*
name@example.com
Today

DayMonthYear
Date
Age
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency contact details

Please enter details of up to two emergency contacts. For persons under 18 years of age, the primary emergency contact must be a legal parent/guardian.
Emergency contact 1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
name@example.com
Emergency contact 2

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
name@example.com
Medical Conditions
Does the above named person require regular medical treatment for any illness or disability?*

YesNo
Please include details below.*
Photography consent
We may use photographs/videos of activity groups on our website and/or social media pages to publicise our work. Please indicate whether you are happy for images/videos of the above named person to be used by PTUAC for such purposes.*

YesNo
Conditions of Use, Rules & Acknowledgment of Risk
Our Conditions of Use and Acknowledgment of Risk Statements are on display within the centre or available by clicking the links.

The following must be adheared to at all times:

• Always follow instructions from instructors/staff (instructor decisions are final)
• Respect equipment and use only as instructed
• Return all equipment after use for correct storage
• Respect other climbers
• Unless specifically approved by PTUAC staff, we don’t allow independent climbing
Have you read and understood the Conditions of Use, Rules, and Acknowledgment of Risk Statement?*
Do you agree to abide by the Conditions of Use and Rules?*
Are you over 18 years of age?*
Can you put on a climbing harness correctly?*
Can you attached a rope to your harness using a suitable climbing knot?*
Can you use a belay device to secure a falling climber and lower a climber from the wall?*
Do you require instruction in any of the above three techniques?*
Do you understand that failure to exercise due care could result in your injury or death?*
Do you have any questions regarding the application of the Conditions of Use or Rules?*
Declaration and Consent
I confirm that the information provided is correct and that I will notify PTUAC of any changes.

I consider the above-named person physically capable of undertaking the activities described and I hereby agree to his/her taking part.

I certify, to the best of my knowledge, that the above named person does not suffer from a medical condition which might have the effect of making an accident more likley, which could result in injury to them or others.

I hereby consent to emergency medical, dental or surgical treatment, including the administration of an anaesthetic, which may be considered necessary for the above-named person (should medical treatment be required for a child, every effort will be made to contact the parent/guardian).
Name*

First NameLast Name
Clear
Parental Consent
I am aware that climbing, hill walking, and mountaineering are activities with a danger of personal injury or death. I have understood the nature of the activity and accept the risk involved. I confirm I am the parent/guardian of the above named child and that I consent for him/her to take part. I consent to any emergency medical treatment necessary during the course of the events including the administration of anaesthetics have read the BMC booklet entitled 'Young People A Parent's Guide'
Name of legal parent/guardian*

First NameLast Name
Signature of legal parent/guardian*

Clear
Should be Empty:

Registration Form

Participation Statement

Participant's Personal Details

Emergency contact details

Medical Conditions

Photography consent

Conditions of Use, Rules & Acknowledgment of Risk

Declaration and Consent

Parental Consent