Neurokin Walk and Talk Registration Form
This form must be filled in to take part in Neurokin Walk and Talk and also agree to the declaimer
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Name *
Address (Please include postcode and town) *
Date of Birth *
MM
/
DD
/
YYYY
What neurological difference do you have? Please tick the following *
What is the reason behind joining our Neurokin Walk and Talk sessions. Please tick *
Required
Which walk and talk locations appeal to you? *
Required
What neurodiverse conditions do you have? (e.g: Autism, ADHD, etc) *
Emergency contact
Please provide at least 1 person to contact in case of an emergency
Person 1 Name *
Person 1 Address *
Person 1 Telephone Number (Mobile/Home) *
Person 2 Name
Person 2 Address
Person 2 Telephone Number (Mobile/Home)
DISCLAIMER FOR WALKS AND OTHER OUTDOOR ACTIVITIES
Everyone taking part in the Group activities does so at their own risk.
We do not employ qualified guides or first aiders on any of our events. The group works on the same basis of being a group of friends who go out walking together, who invite others to join them on this basis.
Event organisers and event hosts assume no responsibility for anyone attending any group event.
TVB will not be held responsible for any accident, injury or loss occurring as a result of any Group event or in connection with travel to such event, however caused.
When you join a walk or other event, you indicate that you accept these conditions and accept that no legal liability is accepted by TVB, group organisers, event organisers or event hosts in the event of accident or injury, however caused.
Participants in Group events are reminded to wear appropriate footwear and clothing and TVB does not provide these.
Participants are responsible for assessing their own risk, their own safety .
Any Medical Conditions that may affect the participants during the walk should be notified to the walk leader prior to the start of the walk.
Dogs are usually allowed on walks but this is entirely at the discretion of the walk leader- please see the individual event details or contact the walk leader- dogs must be kept under close control at all times and on a lead where necessary or requested by the walk leader.
You are welcome to bring a camera if you want to take photos of our beautiful area. However, please do not take pictures of other people in the group. People found doing so will be asked to leave the event. It will be up to TVB’s discretion whether or not to allow a return on subsequent walks/events.
I have read the disclaimer and I agree *
Please inform us of any medical conditions (eg: Asthma, Allergies, etc)
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