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Consent form

Please complete the following form prior to attending your course or guided day(s).

    * = required field

    Your name *

    Company name (if relevant)

    Your email address *
    Please double-check this as if it's wrong then we can't send any information to you!

    Telephone number *
    Mobile please, so we can get in touch if there are any last minute issues or changes of plan

    Address *

    Date of birth *

    Course/guided experience that you have booked *

    Date of course/guided experience (click to open the calendar) *

    Do you suffer from any medical condition that we should be aware of? (if yes please give details, including details of any associated medication or treatment)

    Please provide details of an emergency contact for the duration of the activity:

    Name of emergency contact *

    Relationship of emergency contact to you *

    Telephone number of emergency contact *

    I declare that I am in good health and consider myself fit and able to take part in the above activities.

    I recognise that climbing, abseiling, hill walking and mountaineering are activities with a danger of personal injury or death. As a participant in these activities I am aware of and accept these risks and I am responsible for my own actions.

    I acknowledge that Lakeland Ascents accepts no responsibility for accidents or injury to participants, or for loss or damage to my personal effects, unless caused by the negligence of Lakeland Ascents.

    I understand that Lakeland Ascents may take photographs that contain my image over the course of the event and that those photographs may be used by the service provider in future marketing material and on various social media platforms to aid the promotion of Lakeland Ascents. If you do not wish for your photograph to be taken, please let your instructor know.

    I have read and I agree to the above conditions and disclaimers *

    Covid-19 specific questions

    Information on how Lakeland Ascents' are working to keep you and our staff safe during the Covid-19 pandemic can be found by clicking here.

    1: Clients are asked to follow Government guidance on Coronavirus, specifically that you will not travel to nor attend activities or courses with Lakeland Ascents if you should be self-isolating according to national guidelines. Guidance on the specific symptoms and self-isolation measures are clearly available at www.gov.uk/coronavirus

    2: Clients are asked to confirm the following. These questions will be repeated immediately prior to your course or activity:

    That now or at any time in the last 14 days, you:

    - do not have and have not had a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
    - do not have and have not had a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
    - do not have and have not had a loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal.

    and that

    - none of your household are symptomatic of Covid-19 or have been
    - none of your household are self-isolating or have been
    - to the best of your knowledge you have not been in close contact with anyone else who is symptomatic of Covid-19

    I have read and can confirm the points in section 2 above *

    3: You are asked to confirm that you accept the following:

    - that participation in the booked activity or course may increase your risk of exposure to infection with Covid-19 relative to none participation
    - that you agree to inform Lakeland Ascents should you develop any symptoms consistent with Covid-19 any time within 14 days following the end of the activity or course. Your Instructor undertakes to do the same.

    I agree the points in section 3 above*

    Print name - printing your name here is the equivalent of an electronic signature *

    Today's date (click to open the calendar) *

    We strongly recommend you have appropriate insurance cover for the activities to be undertaken. Insurances that we recommend are personal accident, third party liability and contents insurance covering your personal possessions. We also recommend that you also consider insurance that will protect you should you have to cancel the activity close to the activity date, resulting in a loss of your activity fee.

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