Booking Form

Full Name

First NameLast Name

Date of Birth

Address

Street Address

Street Address Line 2

Town/City

Postal / Zip CodeCountry

E-mail

Contact Phone Number

Course/Trip

Date of Course/Trip

DayMonthYear

Names of other participants

Please ensure EACH member of the group fills in a booking form

Relevant Previous Experience

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Have you ever felt pain in your chest when you do physical exercise?

In the past month, have you had chest pain when you were not doing physical activity?

Do you often feel faint, have spells of severe dizziness or have lost consciousness?

Have you ever suffered from unusual shortness of breath at rest or with mild exertion? Do you often feel faint, have spells of severe dizziness or have lost consciousness?

Has the doctor ever said that you have a bone or joint problem (such as arthritis) that has been aggravated by exercise or that may be made worse by exercise?

Do you have either high or low blood pressure?

Are you currently on any prescribed medicines that may affect your ability to exercise?

Are you pregnant or have you had a baby in the last 6 months?

Have you ever suffered from back pain or had any back-related illness or injury?

If you have answered YES to any of the above, please elaborate below

Please list any other relevant medical conditions, allergies and recent injuries

Name of Emergency Contact- this should be someone who is not on the trip with you

First NameLast Name

Relationship to you

e.g. Partner, friend, parent etc

Emergency Contact Phone Number

Are you happy for your guide/instructor to take photos of you during your day?

If you are a parent/guardian and are participating in an activity with your children who are under 18, please enter their names. Please also read the declarations below and sign on their behalf.

"Mountaineering Scotland recognises that climbing, hill walking 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." I have read, understand and accept this participation statement and realise that whilst every effort will made to maximise safety, all of these outdoor activities carry a certain degree of risk.

I understand that I've been recommended to take out appropriate personal accident/cancellation insurance for this trip. In the event of Lochaber Guides cancelling, I will receive a full refund (or alternative date). If I cancel less than 4 weeks before the date of the course/trip I will receive no refund.

I have read, understand and accept Lochaber Guides' Terms and Conditions. (available on the website)

Signature

Do you wish to make payment? (Please note bookings are only confirmed upon receipt of deposit if more than 4 weeks until trip date and full payment if trip is less than 4 weeks away)

Bank Transfer Details

Please make a manual BACS transfer to the account detailed below.

We will send you a confirmation once this has been received at our end.

Please enter your Surname and the Course/Trip you would like to book as the Payment Reference.

Starling Bank

Account Name- David Anderson

Account No: 27298223

Sort Code:60-83-71

International Transfers: Please note you are responsible for any bank fees/charges incurred. We recommend using a service such as Wise to reduce fees

IBAN: GB55SRLG60837127298223

BIC:SRLGGB2L

Payment Amount

GBPDescription

Booking Form

Medical

Emergency Contact Info

Payment Amount

Payment Methods