Booking Form - Black Grouse

Please Complete The Form

Name of Course/Expedition *

Date of Course/Expedition *

Your Name *

First

Last

Address *

Post Code *

Telephone *

Email *

Confirm Email

Emergency Contact Name *

First

Last

Their Telephone Number *

Briefly tell us a bit about your paddle boarding experience. *

Do you have any medical conditions and/or are you receiving any treatment or medication that we should be made aware of? This should include asthma, allergies, injuries, heart condition etc. If yes, provide details: (copy) *

Do you have any special dietary requirements? *

Do you consent to the taking of photographs & video as means of promoting the business through displays, presentations, social media, and website? *

Paragraph Text

Declaration *

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 & agree that I will not attend or take part in any activity if testing positive for Covid-19 on the date of my activity.
I understand that all activities take place 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 & should an instructor feel I am jeopardising the safety of myself and/or others I will be excluded from the activity without refund.
I consent to any emergency medical treatment necessary by on-site first aiders or qualified medical respondents in the event of an accident.

Todays Date *

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