Booking and Medical - Steeply Inclined

Date(s) of Activity

In format dd/mm/yyyy

Activity / Event

Full Name

For U18s the parent or guardian must complete this form

Gender

Date of Birth

Full Address (including postcode)

Contact Number

Email

Emergency Contact Name and Number

Only for use in emergency

Details of any medical conditions or recent injuries

If not applicable please type “None” above

Details of any prescription medication, allergies or intolerances

If not applicable please type “None” above

or Shoe Name

Please list any additional needs or information you feel is relevant to the booking or activity

Hire Equipment Required

All ropes and technical climbing hardware will be provided though you are welcome to bring your own gear also. For shoes and/or harness hire, please provide sizes below

Shoe Size

Only required if hiring shoes (In Euro or UK)

Waist Size (approx)

Only required if hiring harness (cm or “)

Acknowledgement of Risk

Yes

I accept that the nature of the activities and environments in which they take place carry inherent objective risks which cannot be completely removed. I accept responsibility for my actions and involvement in these activities.

Imagery Consent (Optional)

Yes

I give consent to be included in photographs and/or videos taken during this event and for these to be used in publically available promotional material.

Communications Consent (Optional)

Yes

I give consent to receive occasional communications from Steeply Inclined (via email, text or WhatsApp) with details of courses, activities and offers which may be of interest. I understand that I can opt-out of this at any time.