Parental Consent Form

Please complete the following form prior to the young person attending their course or activity.

* indicates required field

Your name:*

Your email address:*

Your telephone number (mobile):*

Your address:*

Course or activity:*

Date of course or activity:*

Participants name:*

Participants date of birth:*

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

I recognise that if the participant suffers from any medical condition, it is my responsibility to ensure that any necessary medication is supplied, carried and administered by me.

I declare that the participant is in good health and that I consider him/her 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. I am aware of and accept these risks and I accept that the participant is responsible for his/her own actions under my supervision.

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

I understand that Lakeland Ascents may take photographs that contain the participant’s 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 the participant's photograph to be taken, please let your instructor know.

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

Print name (this is the equivalent of you providing an electronic signature):*

Relationship to participant:*

Date:

We strongly recommend that you have appropriate insurance cover for the activities that you will be taking part in. Consider cover for unforeseen last minute cancellation, personal accident, third party liability and loss or damage of your personal possessions.