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PARTICIPANT CONSENT FORM & RISK ACKNOWLEDGMENT

Obstacle Training Ground

Consent for a Participant to take part in obstacle course activities at Obstacle Training Ground (“OTG”)

CONSENT & RISK ACKNOWLEDGMENT
(Also signed by Parent or Guardian if participant is under 16)

I consent to take part in activities at OTG. In providing my consent I declare that I understand that the obstacle course activities themselves are not completely free from risk. I accept that whilst OTG staff will take the appropriate precautions to prevent accidents, this can never be guaranteed.

I confirm that I am physically fit and healthy and I undertake to advise OTG of any change in this regard. I give consent that in the event of any illness/accident any necessary treatment can be administered to me. 

ACTIVITY RULES

All users agree that they shall not participate in any activities provided by OTG unless they have undertaken OTG’s safety and induction procedures and processes in relation to the activities and confirm that they will comply with the rules at all times whilst on the premises.  The rules are clearly displayed in the booking cabin.

These rules are for your own safety and that of others around you.

ANYONE NOT OBEYING THESE RULES WILL BE ASKED TO LEAVE.

Today's Date: February 22, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
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*
Check to receive information, news, and discounts by e-mail.
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Does the Participant suffer from any illnesses/medical conditions or allergies? (please list)

Is the Participant on any medication (please state medication and reasons)

*Please supply any additional information on conditions which may require extra consideration by OTG.
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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