Parental Consent Form

* = required field

Your name *

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 *

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? *
---MorningAfternoonFull dayMore than 1 daySplit over more than 1 day

Name of participant *

Their date of birth *

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

I recognise that if the participant suffers from any medical condition, it is my responsibility to ensure that any necessary medication is supplied and carried. I also understand that any medication must be administered by me personally.

I declare that the participant is in good health and that I consider him/her 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. I am aware of and accept these risks and I accept that the participant is responsible for his/her own actions under my supervision.

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

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

I have read and agree to the above conditions and disclaimers and I confirm that this young person will be accompanied by their parent or legal guardian during the activity. *

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

Relationship to participant *

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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