INTENSE ADVENTURE CONSENT FORM All participants must have a completed consent form before taking part in any instructed session with Intense Adventure Ltd. Where the participant is under 18 the form must be completed and signed by a Parent/Guardian. It is important for the safety and wellbeing of the participant and group members that you provide details of all current and previous injuries or medical conditions. All consent forms are valid for the duration of the programme. A new form should be completed for each programme the participant takes part in. Any changes to the information recorded on this form after its submission must be passed on to Intense Adventure Ltd in writing, as soon as possible. It is important all participants and parents/guardians are aware of the following before taking part in an instructed session with Intense Adventure Ltd.Terms of Instruction It is important all participants and parents/guardians are aware of the following before taking part in an instructed session with Intense Adventure Ltd. Adventurous activities such as those undertaken with Intense Adventure Ltd carry with them an inherent risk of personal injury or fatality. Where possible these risks have been assessed and appropriate control measures put in place to minimise them. This is supported by following guidance provided by National Governing Bodies and industry best practices. Intense Adventure Ltd will cover all participants taking part in instructed sessions with appropriate insurance. Details of insurance cover and certificates are available upon request. Intense Adventure Ltd do not accept any liability for the loss or damage of any personal equipment at any time. Levels of supervision will vary according to the needs of the group and programme. This supervision may include remote supervision where required by the activity or programme. Further details on the type and level of supervision can be discussed with the course leader. In the event of an emergency an Intense Adventure Ltd approved member of staff may make an emergency decision on the Participant/Parent/Guardians behalf, including permission for medical treatment in line with information held on the consent form. Participants must be aware of the need for responsible behavior and to follow any advice or safety instruction. Intense Adventure Ltd reserves the right to withdraw individuals or suspend/cancel programmes where it is felt participants pose a danger to themselves or others. Whilst every effort is made to make the activity inclusive and accessible to all, there may be occasions where participants, who are deemed to be unfit to participate in an activity or programme, may be withdrawn by the Instructor at any time in the run-up to, or during the program where it is felt participants pose a danger to themselves or others. This form must be completed and signed by the parent or guardian if the participant is under 18 years old and by the participant if he/she is over 18 years, and returned to the programme organizer. It is important for the safety and well being of yourself and others that you provide details of all current and past medical conditions. THIS INFORMATION WILL BE KEPT STRICTLY CONFIDENTIALContact InformationFull Name of Participant *Date of Birth *dd/mm/yyyyGender *Address *Participant Mobile No *Participant Email Dietary & Medical informationPlease provide details of Special Dietary Requirements Leave blank if not applicableIs the participant currently undergoing any medical treatment or taking any medication? If yes please provide details belowYesNo Does the participant have any existing long-term injuries or allergies that may affect their participation in physical activity or any part of the programme? If yes please provide details belowYesNo Has the participant come into contact with any contagious Illness In the last 4 weeks? e.g. Chicken Pox, Impetigo etc. If yes please provide details belowYesNo Is the participants tetanus immunisation up to date? YesNoAdd my details (or parental details for minors) to our database which may be used to send you information of future programmes. YesNoEmergency Contact DetailsFull name of Parent/Guardian *Emergency Contact Name Same as above Emergency Contact No *Address Same as Participant Relationship to Participant Second Emergency Contact Name Second Emergency Contact No I parent/guardian confirm the details above are accurate to the best of my knowledge. I have read and understood Intense Adventure Ltd's terms of Instruction.Please enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
