Medical and Consent Form Go backYour message has been sent Name(required) Warning Address(required) Warning Post Code(required) Warning Date of Birth (DD/MM/YYYY)(required) Warning Emergency Contact Name(required) Warning Emergency Contact Phone Number(required) Warning Do you have any Medical Conditions we need to be aware of?(required) Yes No Warning Medical Conditions Warning Are you on any Prescribed Medication?(required) Yes No Warning Prescribed Medication Warning Do you have any Allergies?(required) Yes No Warning Allergies Warning Do you have any other Conditions that we need to be aware of?(required) Yes No Warning Any other Conditions Warning Have you received a Tetanus Injection in the last 10 years?(required) Yes No Warning By submitting this form I agree that the information provided is accurate and that I agree to the statements below. 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. I agree to taking part in the booked activity and I support the need for responsible behaviour during this activity. I understand that photographs taken and feedback given could be used for publicity purposes. This data will be held in accordance with current data protection laws, ICO Registration Number ZA787320. Warning. Submit Medical & Consent FormSubmitting form Δ Share this: Click to share on X (Opens in new window) X Click to share on Facebook (Opens in new window) Facebook Like Loading...
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