Consent

Consent Forms

Please fill in the below forms relevant to the age group of those taking part.

OVER 18 Consent Form

Group Name (School, Youth Group, Private Group Booking) *

* Indicates required field

Name *

First

Last

Date of Birth *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Details

Emergency Contact *

Emergency Contact Number *

Medical Conditions

Do you suffer from any of the following, if yes please give details.
Asthma/Bronchitis/Tuberculosis/Epilepsy/Fainting/Chest Problems/Diabetes/Migraines/Raised Blood Pressure/Heart Trouble

Details *

Medication
Are you taking any regular medication, if yes please give details below

Details *

Allergies
Do you have any allergies, if yes please give details

Details *

Acknowledgment of Risk

Please read the following carefully, once you have read it please indicate your agreement by signing below.
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. The Wilderness Company 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. The Wilderness Company reserves the right to cancel or modify any activity if it believes there to be unacceptable risk attached in offering such an activity. The Wilderness Company’s decision making is at its sole discretion.
I understand that I am taking part in activities provided by The Wilderness Company at my own risk and understand that The Wilderness Company are not able to eliminate all risks from the activities. I accept that The Wilderness Company will not accept any liability for any damage to or loss of property belonging to customers, except in the case of death or personal injury caused by the negligence of The Wilderness Company staff.
Data Protection:
Your personal details will be stored and used by The Wilderness Company to send you important information on matters relating to your booking. Your information will NOT be shared with other organisations or used for any other purpose without your consent.
I hereby agree to participate in adventure activities provided by The Wilderness Company. I have read and understood the Acknowledgement of Risk and have completed the Medical Information section. I also agree to my 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 visit to The Wilderness Company

Signed *

Submit

UNder 18 Consent Form

Group Name (School, Youth Group, Private Group Booking) *

* Indicates required field

Childs Name *

First

Last

Parents/Guardians Email *

Parents/Guardian Name *

Childs Date of Birth *

Parents/Guardians Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Details
Please give an additional contact

Emergency Contact *

Emergency Contact Number *

Medical Conditions

Does the child you suffer from any of the following, if yes please give details.
Asthma/Bronchitis/Tuberculosis/Epilepsy/Fainting/Chest Problems/Diabetes/Migraines/Raised Blood Pressure/Heart Trouble

Others that may be relevant.

Details *

Medication
Is the child taking any regular medication, if yes please give details below

Details *

Allergies
Does the child have any allergies, if yes please give details

Details *

Acknowledgment of Risk

Please read the following carefully, once you have read it please indicate your agreement by signing below.
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. The Wilderness Company 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. The Wilderness Company reserves the right to cancel or modify any activity if it believes there to be unacceptable risk attached in offering such an activity. The Wilderness Company’s decision making is at its sole discretion.
I understand that the child named is taking part in activities provided by The Wilderness Company at your own risk and understand that The Wilderness Company are not able to eliminate all risks from the activities. I accept that The Wilderness Company will not accept any liability for any damage to or loss of property belonging to customers, except in the case of death or personal injury caused by the negligence of The Wilderness Company staff.
Data Protection:
Your personal details will be stored and used by The Wilderness Company to send you important information on matters relating to your booking. Your information will NOT be shared with other organisations or used for any other purpose without your consent.
I hereby give my consent for the child named to participate in adventure activities provided by The Wilderness Company. I have read and understood the Acknowledgement of Risk and have completed the Medical Information section. I also agree to the child named 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 visit to The Wilderness Company

Signed *

Submit

Consent Forms

OVER 18 Consent Form

UNder 18 Consent Form

Get in touch

Telephone 01913235115
01913235115
Email [email protected]

Find us on Social Media

Head Office

Crag Pond

Base Camp

Consent Forms

OVER 18 Consent Form

UNder 18 Consent Form

Get in touch

Telephone 0191323511501913235115Email [email protected]​Find us on Social Media

Head Office

Crag Pond

​Base Camp

Telephone 01913235115
01913235115
Email [email protected]

Find us on Social Media

Base Camp