Activity Consent

Participant Details

Please provide details for the person taking part in the activity

Name

First Name

Last Name

Address

Telephone number

Please provide parent/carer phone for young people

Please provide parent/carer email for young people

Date of Birth

Emergency Contact

Parent/Carer details or preferred emergency contact

Name

First Name

Last Name

Address

Telephone number

Additional information

Do we need to provide any extra help?

For example because of a disability, or are there any activities that the participant cannot participate in?

Do we need to know about any medical conditions or allergies?

If yes, please provide details of the condition(s) and any medication needed. Please include any food allergies / intolerances so that we may cater to the participants needs adequately.

Is there anything else you think we should know?

Activity consent

The participant taking part in the stated activity

I agree

Urban Bushcraft keeping a record of this form for health and safety reasons

I agree

Any medical treatment the participant may need to be given in an emergency

I agree

Keep me in the loop

Urban Bushcraft contacting me via email in relation to upcoming events and activities

Yes, please keep me informed

No, please do not send me details of upcoming activities

The participant being filmed or photographed during the activity, with the possibility that these photographs/media recordings may be used for publications or marketing publicity. Urban Bushcraft will take all steps to ensure these images are used solely for the purposes for which they are intended.

Note: if consent is not given, Urban Bushcraft will not use any images taken during the activity that contain the participant

Yes