Suitability To Participate Form Health and safety whilst taking part in our activities is of paramount importance to us. PLEASE ANSWER THE FOLLOWING QUESTIONS AS ACCURATELY AS POSSIBLE AND RETURN BEFORE THE DAY OF THE ACTIVITY Participant Details Participant Name Date of Birth Participant's Email Address Participant's Contact Number Address Date of Attendance Group / Booking Name Emergency Contact Name of Emergency Contact Relationship with Emergency Contact Day Time Number for Emergency Contact Mobile Number for Emergency Contact Email Address for Emergency Contact Emergency Contact 2 Name of Emergency Contact Relationship with Emergency Contact Day Time Number for Emergency Contact Mobile Number for Emergency Contact Email Address for Emergency Contact Medical Details Doctor Telephone Number for Doctor Do you suffer from any medical conditions? NoYes Medical Conditions Do you suffer from any serious allergy? NoYes Allergies Have you had any recent illness or injury? NoYes Illness or Injury Do you have a disability? NoYes Disability Do you need to carry any medication on your visit, e.g. inhalers, EpiPens, etc? NoYes Medication Do you have any special dietary requirements? NoYes Dietary Requirements Are you able to swim? ---YesNo Is there any other information you consider important for us to know? (e.g. fears, behavioural issues, etc) Photography/Videoing The centre will occasionally take photographs while you undertake activities for promotional purposes including posting on our social media pages. If you do not want your photograph to be used for these purposes, please choose "No". ---YesNo Promotion and Marketing We would like to send you emails from time to time with information about our activities and facilities. Please indicate your preference by selecting "Yes" or "No" ---YesNo Declaration I agree that I have answered all of the above questions as accurately as possible and that I consider I am fit enough to participate in the Centre’s activities. Fairburn Activity Centre recognises that participation in outdoor activities and the outdoor environment come with a danger of personal injury or death. We risk assess our activities and can provide these documents if you would like to understand the risks of each activity better. I accept that Fairburn Activity Centre will not be held liable in the case of an accident or injury unless staff and management have failed to take reasonable steps in their duty of care, and I accept the risks involved in the activities that I am about to undertake. I agree to Fairburn Activity Centre staff giving first aid provision and treatment in the first instance of an accident and/or injury. I agree that Fairburn Activity Centre may retain these details in compliance with the General Data Protection Regulation 2018. I Accept The Above Declarations Sign me up for the newsletter!
