Medical Form

Thank you for signing up to our hike / adventure. Please fill in your medical form before the adventure.

Participant first name

Participant last name

Email

Phone

Emergency contact name:

Emergency contact phone:

Medical conditions, disabilities, allergies or special requirements

Please list all pre-existing medical conditions, disabilities, allergies, special requirements or recent illnesses that may affect your participation in this activity. Please give full details of your condition(s), as this helps us provide an enjoyable and rewarding day for all. If you have a preexisting medical condition that may make it unsafe for you to take part in this activity, then it may be necessary to seek advice from your GP or medical specialist (we will contact you about this). Please ensure that you bring any medication that you may need with you on your activity. All information will be treated in confidence.

Terms and Conditions

I confirm that I am the participant.

Yes

Parent / Legal Guardian

I am aware that valley, hill and mountain walking are activities that have an inherent and unavoidable risk of accident, personal injury or death. I understand the nature of the activity I have chosen to take part in and accept the risks involved.

Do you have any medical conditions / injuries that I need to be aware of?

I consent to emergency medical treatment or medication to be administered to me during the activity in the event of injury /accident.

Do you require medication? Do we need to be aware of this? If so, which medication?

I confirm that I have a reasonable and suitable level of fitness and ability for my chosen activity.

I undertake to inform Essex Adventures of any material changes to the personal information I have provided on this Consent Form between signing this form and the day of the walk.

By completing this Consent Form I confirm that I have read through, understood and accepted the Terms & Conditions detailed above; I am fully aware of the type of activity I will be undertaking; I consent to my participation.

I confirm that the information I have provided on this Consent Form is accurate and complete.

Date picker

Name:

Signed, Sealed, Delivered!

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Medical Form

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