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XC - Climbing & Skatepark

Jarman Park,

Hemel Hempstead,

Hertfordshire,

HP2 4JS

The Lost Mine Adventure
in the XC Caving System

Acknowledgment of Risk

Participation Statement

This caving type activity has a risk of injury. Participants must accept that even if they follow good practice there is still the risk of accident and injury. It is the responsibility of the participant to adhere to the conditions of use. Bumps, bruises, cuts, grazes, and minor sprains and strains are common. There are inherent risks which cannot be removed. By signing this form, you are stating you understand that these risks cannot be completely removed. If you do not understand any of the terminology or content, ask a member of staff to clarify.


Conditions of use

General Safety

  • Report to reception on each visit before you enter the Lost Mine.
  • Before entry into the mines you will receive either a verbal or video safety and mission briefing - or both! This guidance must be followed at all times.
  • You must exercise care, common sense and self-preservation at all times.
  • Report any problems with the caves or other cavers' behaviour to a member of staff immediately.
  • Be aware of the other cavers around you and how your actions will affect them.
  • Please make yourself aware of the location of the fire exits in the building and fire assembly points.

As an explorer of the Lost Mine, you must be aware of and accept the following:

  • Participants must understand that taking part while pregnant can increase the risk posed to mother and unborn child.
  • You must do everything reasonable and practical to avoid endangering yourself or others.
  • You have to be aware of and adhere to the safety rules of the centre at all times.
  • Please empty your pockets and remove all jewellery before entering the Mines.

Exploring the Mine

  • All adventurers are required to wear a helmet and head torch at all times whilst exploring the mines.
  • A minimum of two and a maximum of 12 participants (plus relevant instructors) are permitted to access the Mine at any one time.
  • Adults and children are not permitted to enter the mines at the same time unless they are part of the same party or family.
  • If you wish to leave the mines, you must inform your instructor before heading downstairs.
  • You must be aware that the caving system is not lit, has restricted width and height and is a closed and uneven environment. If you or any of your group have suffered from claustrophobia in the past, or currently, then this experience is not for you. If you are looking at booking a party package which includes caving you should first ensure that all participants are not scared of tight or confined spaces.
  • You must remove any objects from your person that could cause damage to the system or harm to yourself or others.
  • Wear older clothing that you don't mind being dirty or damaged
  • You must remove all jewellery and pocket contents, wear clean closed top shoes that can be securely fastened and tie all long hair back in a low pony tail.
  • Clean shoes are essential
  • You must keep noise to a minimum so that you and your instructor can communicate safely.
  • You must have visited the toilet before entering the mine
  • Any concerns or physical or medical conditions must be disclosed to instructors - some conditions may not be suited to the Lost Mine experience and it is vital we know these in advance.

 Our Duty of Care

The conditions of use of the Lost Mine are not intended to limit your enjoyment of the facilities; they are part of the duty of care that we, as operators, owe to you, the customer, by law. As such, they are not negotiable and if you are not prepared to abide by them then the staff may ask you to leave.

Your Duty of Care

You have a duty of care to act responsibly towards the other users of the centre, follow good practice and abide by the conditions of use of the centre. Your Mine Guide will go through these with you in the briefing.

Declarations

I certify that to the best of my knowledge, I do not suffer from a medical condition that might have the effect of making it more likely that I be involved in an accident that could result in injury to myself or others. I also confirm that the above information is correct and if any information changes I will notify the centre.

I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.

 









First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant (or adult if under 18) Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Please answer 'YES' or 'NO' to the following questions
Have you read and understood this Acknowledgement of Risk & conditions of use for the caving system, and that serious injury or death may occur, and that you understand that all participants must obey directions of instructors at all times? (If you have any questions please inform a member of staff asap)*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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