Over 18s Consent Forms

Please fill in below from if you are over 18 and taking part in Wilderness Outdoor Education Ltd activities

* Indicates required field

Name *

First

Last

Date of Birth *

Emergency Contact *

Emergency Contact Number *

Email *

Home Address *

Primary Contact Number *

Secondary Contact Number *

Name of School / Group *

Dates of Visit *

Health and Medical info

Individuals participating in outdoor activities are putting themselves into a situation where trained and responsible adults may have to make decisions of care on their behalf. By participating in outdoor activities, participants may experience environments and conditions where prior knowledge of details of health may prove vital in ensuring the full safety of the participants. For these reasons, we would like to have details of any medical conditions or health issues that may affect involvement in the activity. Please detail any medical conditions or illnesses for which you have been under the care of a health professional, or are taking medication, in the past 6 months.

Does your child suffer from any of the following conditions?

Asthma
Epilepsy
Diabetes
Heart Trouble
Tuberculosis
Chest Problems
Raised Blood Pressure
Bronchitis
Fainting
Migraines

Answer yes or no and give details below if YES *

YES NO

Details *

Do you suffer from any other condition requiring medical treatment, including medication? *

YES NO

Details if Answered YES *

Are you allergic or sensitive to any medication (e.g. Penicillin), insect bites or food? *

YES NO

Details if Answered YES *

Have you been immunised against any diseases? *

YES NO

Details if answered yes *

Are you taking any form of medication on a regular basis? *

YES NO

Details if answered yes (Include dosage) *

To the best of your knowledge, have you been in contact with any contagious or infectious diseases, or suffered any recent condition that may become infectious or contagious? *

YES NO

Details if answered yes *

Do you have any specific dietary requirements? (Include Allergies of Intolerances) *

YES NO

Details if Answered yes *

Name of your Doctor *

Name of Child's Registered Doctors Surgery *

Acknowledgement of Risk

Statement of Risk:
Outdoor and adventurous activities often involve learning new skills in unfamiliar environments. With this in mind the activities have an element of risk, which includes a danger of personal injury or death. Participants and/or their parents/guardians undertaking these activities should be aware of and accept these risks and be responsible for their own actions. Wilderness Outdoor Education ensures that it’s range of safety management systems are inspected regularly by external National Governing Bodies, including the Adventure Activities Licencing Authority, and an external technical advisor. Wilderness OE reserves the right to cancel or modify any activity if it believes there to be unacceptable risk attached in offering such an activity. Wilderness OE decision making is at its sole discretion.
I understand that my child is taking part in activities provided by Wilderness OE at their own risk and understand that Wilderness OE are not able to eliminate all risks from the activities. I accept that Wilderness OE will not accept any liability for any damage to or loss of property belonging to my child, except in the case of death or personal injury caused by the negligence of Wilderness OE staff.
Data Protection:
Your personal details will be stored and used by Wilderness OE to send you important information on matters relating to your booking. Your child’s information will NOT be shared with other organisations or used for any other purpose without your consent.

I hereby give my permission for my child/ward (named above) to participate in adventure activities provided by Wilderness OE. I have read and understood the Acknowledgement of Risk and have completed the Medical Information section.

Signed (your name) *

I also agree to my child/ward receiving medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present. The medical information given in this form will not be retained beyond the completion of your child’s visit to Wilderness OE

Signed (your name) *

Date *

Over 18 Consent Form

Health and Medical info

Acknowledgement of Risk

Location

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