Consent form

Please complete the following form prior to attending your activity.

* = required field

Your name *

Company name (if relevant)

Your email address *
Please double-check this as if it's wrong then we can't send any information to you!

Telephone number *
Mobile please, so we can get in touch if there are any last minute issues or changes of plan

Address *

Date of birth *

Activity that you have booked *
If a gorge or canyon then please state which one

Date of activity (click to open the calendar) *

Which slot? *

Do you suffer from any medical condition that we should be aware of? (if yes please give details, including details of any associated medication or treatment)

Please provide details of an emergency contact for the duration of the activity:

Name of emergency contact *

Relationship of emergency contact to you *

Telephone number of emergency contact *

I declare that I am in good health and consider myself fit and able to take part in the above activities.

I recognise that climbing, abseiling, hill walking and mountaineering are activities with a danger of personal injury or death. As a participant in these activities I am aware of and accept these risks and I am responsible for my own actions.

I acknowledge that Lakeland Ascents accepts no responsibility for accidents or injury to participants, or for loss or damage to my personal effects, unless caused by the negligence of Lakeland Ascents.

I understand that Lakeland Ascents may take photographs that contain my image over the course of the event and that those photographs may be used by the service provider in future marketing material and on various social media platforms to aid the promotion of Lakeland Ascents. If you do not wish for your photograph to be taken, please let your instructor know.

I have read and I agree to the above conditions and disclaimers *

Print name - printing your name here is the equivalent of an electronic signature *

Today's date (click to open the calendar) *

We strongly recommend you have appropriate insurance cover for the activities to be undertaken. Insurances that we recommend are personal accident, third party liability and contents insurance covering your personal possessions. We also recommend that you also consider insurance that will protect you should you have to cancel the activity close to the activity date, resulting in a loss of your activity fee.

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