Consent Form Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Activity NameActivity DateAddressDate of Birth *GenderAny allergies, medical conditions, prescribed medication or advice to be followed in an emergency? *Any special dietary requirements?NoPlease list all pre-existing medical conditions, disabilities, phobias, special requirements or recent illnesses that may affect your time during the activity or whilst outdoors in the woodland. Please ensure that you bring any medication that you may need with you.If yes, please give details belowAny special dietary requirements?YesNoIf yes, please give details belowHave you had an anaphylactic reaction to an insect or bee/wasp sting? *YesNoIf YES, do you carry an EpiPen or similar medication?YesNoEmergency Contact Name *FirstLastPreferred Phone Number *Phone (home)Phone (mobile)Phone (work)Do you consent to the taking of photographs & video as means of promoting the business? We will make use of some or all of the following methods: DisplaysPresentationsSocial mediaWebsiteCheckboxesI give my consent to photographs of the named child being used for publicity by Out to the Woods CIC.I would like to receive occasional emails from Out to the Woods CIC about special offers and upcoming events in the woods.Your Name *FirstLastUnderstanding & Acceptance of Risk *• I confirm that the above details given are true and correct and that I am fit and able to participate in activities. • I understand that all activities take place in the outdoors where conditions may hazardous. I accept that there is an element in unforeseen risk and agree to take part in the organized activities at my own risk • I agree to comply with the safety briefings given by the staff at all times • I have read, understood and agree to comply with the terms and conditions of undertaking an activity with Out to the Woods CIC • I consent to any emergency medical treatment necessary by the on-site first aiders or qualified medical respondents in the event of an accident.Whilst we are dedicated to the safety of our participants and undertake a daily safety check of the area and equipment, there is always an element of unforeseen risk. Anyone wishing to take part in an activity operated by Out to the woods CIC does so with this understanding. Some of the activities offered can be physically demanding therefore, you should be in reasonably good health & physically fit before participating. It is always advisable to seek medical advice if unsure. GDPR Agreement *I consent to Out To The Woods CIC storing my submitted information.DATA PROTECTION We treat security with the highest priority. We hold data about you to run our business efficiently and is not kept longer than is necessary. It is kept safe and securely and handled sensitively in accordance with GDPR legislation. You have the right to ask to see what data we hold for you, to ask us to correct it and also to ask us to remove it from our database. We do not share your data with any third party. Out to the Woods CIC is registered with the Information Commissioner’s Office (Reference ZB047726) and we abide by the responsibilities set out by them as a data controller.Submit
