If the above details are correct, please proceed to the next page to provide Medical Details.
All students, under the age of 16, must have this form completed as fully as possible by a parent or guardian, prior to taking part in any organised activities with Black Mountain Activities Ltd. All information given will be treated with the strictest confidence.
Does your child have a medical condition?
Is your child receiving any medication or treatment?
Does your child suffer from allergies? i.e. stings, bites, penicillin, elastoplasts etc
Is your child prone to repetitive sports injuries?
Can your child swim?
Your child must be able to swim a minimum of 50m to participate in water sports. If not, do you give permission for your child to participate in water sports?
Does your child have any dietary needs? i.e. vegetarian, celiac etc (only applicable if ordered packed lunches)
Do you consent to your child being given paracetamol, if the need arises?
Are there any areas we have not yet covered that you feel may be relevant?
Please provide your child's approx. Height & Weight.
If the above details are correct, please proceed to the final page - Disclaimer.
Whilst we are dedicated to the safety of all our clients and endeavour to ensure all activities are operated to a very high standard of safety, all activities offered by Black Mountain Activities Ltd are operated outdoors where conditions may be wet and slippery therefore, there is always an element of unforeseen risk. All activities offered can be physically demanding therefore, your child should be in reasonably good health & physically fit before participating. It is always advisable to seek medical advice if you are unsure about their health.
Consent / Understanding & Acceptance of Risk
I (the parent/guardian) can confirm that all details given are true and correct and that my child is fit and able to participate in the activities organised.
I (the parent/guardian) understand that all activities take place in the outdoors where conditions may be wet, slippery and hazardous. I accept that there is an element in unforeseen risk and give consent for my child to take part in the organised activities.
I (the parent/guardian) agree to ensure that my child understands, as far as reasonably possible, that is is important for his/her safety, that of their peers and as a whole, any rules and instructions given by staff are strictly adhered to at all times. I understand & agree that should an instructor feel my child is jeopardizing the safety of themselves, and/or others, they will be excluded from the activity without refund.
I (the parent/guardian) consent to any emergency medical treatment necessary to be given to my child by on-site first aiders or qualified medical respondents in the event of an accident.
I (the parent/guardian) consent to Black mountain Activities Ltd taking photographs and video as means of promoting the business through displays, presentations, social media and website.
Please ensure all details provided within this form are correct and up to date. If you should have any queries, please give us a call on 01497 847897.