WildWoodlands Medical and Consent Form

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Name *

Date of Birth *

YYYY

Email *

Phone number *

Address *

Postcode *

Course Title *

Date of Course *

YYYY

I UNDERSTAND THAT *

The course can be physically and mentally demanding and may require excessive exertion and that i will not bring any alcohol or non-prescription drugs. The possibility of personal injury to me and others exsists. The course may expose me to hazards (fire making and cutting instruments, cold and/or heat).

Required

I CONFIRM AND AGREE *

I am aware of the risks to myself and others whilst attending a Wiildwoodlands course and agree to abide by the rules at all times. I am physically fit and mentally able to partake in the course. If i feel unwell to continue i shall alert a member or staff immediately. I agree to comply with the rules as given to me by Wildwoodlands staff, to use all equipment as instructed and to obey all directions given by Wildwoodlands staff.

Required

Do you have any illness or learning difficulties?

Are you under any medication, suffer from any allergies or have any specific dietary needs?

Additional Comments

Emergency Contact Name *

Relationship *

Emergency Contact Number *

I give permission for photographic media taken of me during the course can be uploaded to Wildwoodlands social Media sites (Face book/Instagram and Wildwoodlands Website. *

Yes

I give permission for my email to be used by Wildwoodlands to receive newsletter on future course updates. *

Yes

Declaration *

By ticking this box, you are confirming that you have completed this form truthfully and agree to all of the above

Required

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