consent form

Consent form

    Personal Information

    Emergency contact

    Medical Information

    In the last 5 years have you suffered from any injury or complaint with the following

    If you answered Yes to any of the above please describe the issue

    Any other special needs or medical requirements

    Any other information (e.g. special dietary needs, phobias, fears, activities you wish to avoid, or anything else important)

    - Medical conditions – Please make us aware of any medical conditions that you might require support with so we can be best prepared to assist you. You will not be excluded from any activity on account of your condition unless we believe that it may cause danger for you or others.

    - Medication – At the start of your session you must inform your instructor of any medication you are taking. If a minor needs to take prescription drugs during an activity we must receive notice from an appropriate adult in writing. If you have an inhaler please ensure you bring it with you and keep it accessible.

    - Personal items – Original Wild cannot take responsibility for loss or damage to any personal possessions, valuables, or clothing brought to our activity sessions, locations or left in vehicles.

    I confirm that I have read and understood the information in this document and have completed the medical declaration to the best of my knowledge.

    I confirm that I am able to swim 15 metres unaided.

    I do not have any medical conditions that could cause danger to myself or others whilst undertaking planned activities by Original Wild.

    Original Wild have done their utmost to assess and manage any risk, however I understand I am about to undertake a strenuous outdoor activity which by its nature has an inherent and inevitable level of risk which, however small, cannot be eliminated entirely.

    I will not do anything that may jeopardise my own or others safety.

    I will comply with the instructions given by Original Wild’s team and understand they have the right to take emergency action and make related decisions in the case of such action being considered necessary.

    I acknowledge photographs and videos are taken for training and promotional purposes. Please advise your instructor if you prefer not to be in any photos.

    Signing this declaration does not affect your legal rights or our obligations towards you.

    I understand and agree to the above statements (Signatory must be the parent or guardian if under 18)


    Your Data

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    Please tick the box to confirm that you have read and accept Original Wild’s privacy policy.

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