Medical Declaration and Consent Form

Each participant is required to submit the Medical Declaration and Consent form below.

Full Name

Address

Phone Number

Date of Birth

Date of Adventure (YYYY-MM-DD)

Adventure taking part in

Do you have any medical conditions or allergies which your instructor should be aware of, which may affect your ability to participate, or which may require sudden treatment during your course? (required)

Yes

If you answered yes to the previous question, please provide details.

We need to be aware of any medicines that you will be bringing on the day with you and how to administer such medicines in case of emergency eg. Insulin.

Medical Information

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

I consider myself to be fit and in good health and there is no medical reason why I should not participate in mountain walking, scrambling, rock climbing and navigational activities offered by my instructor. In the event of an accident during my activity, I give full permission for the relevant instructors, who is suitably trained in First Aid, to administer whatever First Aid treatment they deem appropriate under the circumstances (except as listed above).(required)

Yes

Please read the following statements carefully:

I realise and accept that mountain walking, scrambling, rock climbing, navigation are activities which carry a danger of personal injury as they take place in mountain terrain. I am aware of and accept these risks and will be responsible for my own actions and involvement in such activities.

While on the course and in the care of my instructors, I agree to abide by any instructions and decisions made by the instructor regarding individuals and the group as a whole. If I choose to disregard any advice given by the instructor before, during or after the course, I do so voluntarily and accept liability for all resulting injuries or damage.

I understand that my instructor and Snowdon Hikes accepts no responsibility for accidents or injury to participants or for loss of or damage to personal effects, unless caused by negligence on the part of my instructor.

Please tick to accept the above statements(required)

I accept and understand.

Marketing and Social Media

During activities your instructor may take photographs. These photographs may be used for publicity and marketing purposes in the future. Please check the box below if you are happy for your photograph to be taken.

Yes

Consent Declaration

I declare that I have read and understood all of the above information. Please write your name and date in this box below: