Medical and consent form bushcraft course

Type Of Course*

Please select the type of course you are joining

Name*

First Last

Date*

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email

Phone

Email*

Date Of Course*

1. The course can be physically and mentally demanding and may require excessive exertion. 2. The possibility of personal injury to me and others exists 3. The course may expose me to hazards (Burns, Cuts, feeling cold or hot)

1. I am aware of the risks to myself and others whilst attending a Wildway Bushcraft course and agree to abide by the rules at all times. 2. I am physically fit and mentally able to partake in the bushcraft course. If I feel to unwell to continue I shall alert a member of staff immediately. 3. I agree to comply with the rules as given to me by Wildway bushcraft staff, to use all equipment as instructed and obey all directions given by Wildway bushcraft staff.

MEDICAL QUESTIONS*

Do you have a history of any other illness or learning difficulty not mentioned above . If so,please state illness below:

Are you under any medication at the moment ? If so please give details below.

EMERGENCY CONTACT DETAILS

Name*

First Last

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone*

Relationship*

By ticking this box you are confirming you have completed this form truthfully and agree to all of the above*

I agree

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Medical and Consent

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