Woodland Adventure Days with The SHAC
Emergency contact, Permission and Medical form.
Email address *
Please enter your Adventurers Name/s (Child's Name/s) You can add mulitiple names here if required. *
Your answer
Please enter date of birth of your adventurer. *
Your answer
Parent/Guardian Full name *
Your answer
Emergency Phone number *
Your answer
Please add dates attending below. *
Your answer
Medical Conditions - Please provide details of allergies, conditions and any medication required and provided on the day.
Your answer
Please confirm that you give permission for your child to partake in all activities including but not limited to: Fire Lighting and management under instruction, camp building, bushcraft, rope swings, tree climbing and use of tools including but not limited to, knives, axes and saws. *
Do you allow us to take and use pictures of your child for marketing purposes? *
Disclaimer: The Surrey Hills Adventure Company accepts no responsibility whatsoever for any injury or illness sustained or suffered by any person or persons so engaging in any activities offered by ourselves. We also accept no responsibility for any loss or damage to personal belongings however caused, whether due to negligence of ourselves or arising from the use of activities made available. *
Required
Please make payment of £40.00 for each participant to the following account to conclude your booking: Account Name: The Surrey Hills Adventure Company - Bank: Barclays - Account Number: 83892123 - Sort Code: 20 24 00 (Please use your name as Payment Reference) *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.