Consent

When booking any course or participating in an activity with Charles as your leader you will be required to submit the Medical Declaration and Consent form below.

Please note: So that I have accurate and up-to-date information, all participants need to complete these forms for each course even if you have attended in the past. I reserve the right to refuse participation if the following forms are not received within three days of the course start date.

Medical Declaration and Consent Form

Your name

Your email

Your Address

Your Date of Birth

Medical Conditions

Do you have any medical conditions or allergies which we should be aware of, which may affect your ability to participate, or which may require sudden treatment during your course?

Yes (please provide details)No

If you answered yes to the previous question, please provide details.

Are you currently taking any medication which we should be aware of?
Yes (please provide details)No

If you answered yes to the previous question, please provide details.

Are you allergic to any medication, or are there any medications or treatments that you would not wish to receive?
Yes (please provide details)No

If you answered yes to the previous question, please provide details.

Medical Declaration *

I consider myself to be fit and in good health and there is no medical reason why I should not participate in hill and mountain walking, wild camping and navigational activities offered by Charles Smith. In the event of an accident, I consent to Charles Smith or participating instructors, who are suitably trained in First Aid, to administer whatever First Aid treatment they deem appropriate under the circumstances (except as listed above).
YesNo

Please read the following statements and click Yes to confirm you have read and understood and agree to the the terms and conditions stated here.

I accept that mountain training, walking and wild camping are activities which carry a danger of personal injury as they take place in hill and mountain terrain. I am aware of and accept these risks and will be responsible for my own actions and involvement in such activities.

I agree to abide by any instructions and decisions made by the instructor regarding individuals and the group as a whole. If I choose to disregard any advice given by Charles before, during or after the course, I do so voluntarily and accept liability for all resulting injuries or damage.

I understand that Charles Smith accepts no responsibility for accidents or injury to participants or for loss of or damage to personal effects, unless caused by negligence on the part of Charles Smith and its instructors.

I Accept: