Information Form

We’re so pleased you’re joining us on an event. To help us to provide the best experience please complete this form.

Event

Choose the event you are attending by clicking the arrow and scrolling to the event

Title:

Name

First Name

Last Name

Email Address

Date of birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Number

How did you hear about us?

Emergency contact details

Please provide the name of someone we can contact in the case of emergency. This should be someone not attending the event

Name

First Name

Last Name

Emergency contact number

Relationship to you

Medical information

Do you have any medical conditions that we should be aware of? This should include injuries, restricted mobility, asthma, allergies, heart condition, pregnancy, medicines taken etc. If yes, please give details

Dietary information

Do you have any special dietary requirements or food allergies? If yes, please give details.

Understanding & Acceptance of Risk

Whilst we are dedicated to the safety of our clients & endeavour to ensure all activities are operated to a very high standard of safety, there is always an element of unforeseen risk. Anyone wishing to take part in an activity operated by Nature Escapes does so with this understanding. While we offer different levels of activity and are dedicated to providing adventure for all abilities you should be in reasonably good health & physically fit before participating. It is always advisable to seek medical advice if unsure. I confirm that the above details given are true and correct and that I am fit and able to participate in the activities. I understand that activities take place in the outdoors where conditions may be wet, slippery and hazardous. I accept that there is an element in unforeseen risk and agree to take part in the organised activities at my own risk. I agree to comply with the rules & regulations given by the staff at all times and should an instructor feel I am jeopardising the safety of myself and/or others I will be excluded from the activity. I understand that at this event or related activities I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, organisers, and/or assigns. If this causes any problems just let us know.

I agree to understanding & acceptance of risk

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