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 a session 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 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 occasionally taken for training and promotional purposes (please write on this form if you do not wish to be photographed).
    If you do not want to receive inspiration, information on future courses, discounts or offers from us please tick here . 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)

    Signature


    Your Data

    By ticking the box below, you are consenting to allow Original Wild to store and process the personal information submitted above to provide you the content requested.
    For more information on our privacy practices and how we are committed to protecting and respecting your privacy, please review our
    Privacy Policy.
    Please tick the box to confirm that you have read and accept Original Wild’s privacy policy.