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Parental Consent

I am aware that climbing, hill walking and mountaineering are activities with a danger of personal injury or death. I have understood the nature of the activity and accept the risk involved. I confirm that I am the parent/guardian of the above named child and that I consent for him or her to take part in bouldering at Fenrock. I consent to any emergancy medical treatment necrssary during the course of the events including the administraion of anaesthetics. I have read the CMC booklet entitled 'young people - a parent's guide'

BMC Participation Statement

The BMC recognises that climbing, hill walking and mountaineering are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement

Today's Date: June 18, 2021

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
First Participant's Signature*
Second Participant's Name

First Name*

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

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
Third Participant's Name

First Name*

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

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
Fourth Participant's Name

First Name*

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

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
Fifth Participant's Name

First Name*

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

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
Sixth Participant's Name

First Name*

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

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
Seventh Participant's Name

First Name*

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

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
Eighth Participant's Name

First Name*

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

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
Ninth Participant's Name

First Name*

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

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
Tenth Participant's Name

First Name*

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

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Medical Matters 


Does your son/daughter have any medical problems you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Please include below details of any medicines being taken, any allergies e.g. penicillin, plasters etc or special dietary or other treatment necessary 


Medicine/Tablets

Allergies

Dietary requirements

Other treatment

His/Her National Health Service Medical Card No (if known)

His/Her doctor's name and surgery address

Doctor's telephone numbers

Any Religious needs
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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