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Consent Form

Consent and Risk Disclaimer

All outdoor education and adventure activities by nature have inherent risks and dangers. By participating in these activities you are exposing yourself to these risks. Experienced, trained & qualified staff combined with appropriate safety equipment, help manage and reduce the risks. Nonetheless the risks and danger will never disappear. West End Adventure Group do not supply participants personal accident and belongings insurance. 

 

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
Participant's Address
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 Email Address

Email*

Confirm Email*
We would love to keep you informed of special events and deals,if you don't want to receive this please uncheck the box..
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
How did you hear about us?

How did you hear about us? *
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.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
What is the attendee's current school
Attendees current school year group*
Please select the attendees shoe size (approx)*
Please select your jacket size*

Please enter the attendees postal code: *

Doctors name and Surgery
Does your child have any dietry requirements?*
No
Yes

If yes, please give detail below
Any medical information we need to know to ensure that your child is safe during the week?*
No
Yes

Please give details:

Any additional notes or requests?

We reserve the right to cancel any activity and customers will receive a full refund. Due notice will be given 24 hours prior to the availability start time in the event of such cancellation requirement.

Please check to confirm that all attendees are over the age of 5.
I acknowledge that photographs will be taken during the week so that children have a record of what they have done. These will be posted with no name associated to them on our Facebook page, Twitter, Instagram and on our Webpage.
Please check this box to indicate you have agreed to our terms & conditions.
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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