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

Equipment additional the

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

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

Hire Equipment Required

All ropes will be provided, you are welcome to use your own hardware. 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 (In cm or “)

Acknowledgement of Risk

I accept

Climbing and mountaineering are potentially hazardous activities. You must be aware of and accept these risks and take responsibility for your own actions and involvement. Ticking this box confirms that the information you have supplied is full and complete and that you have read and understood the acknowledgement of risk