Climbing & abseiling permission form

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Climbing &
ABSEILING
Permission
form

Climbing/Abseiling Permission Form

This form gives permission for your child to attend the activity and gives the Activity leader authority to sign on your behalf any papers needed by the medical authorities in the case of emergency treatment.

I give my permission and consent for my Son/Daughter to take part in Climbing/Abseiling. *

Yes, I agree.

Activity Location: *

Event/Activity Date *

Young Persons Details

Please enter the young persons details

Add Young Person Details

First Name *

Last Name *

Date of Birth *

E.g. 01-01-2000

Gender *

Group

Doctors Name & Address *

Does your child have any known sensitivities, Dietary requirements or allergies (e.g. Penicillin, special needs.)? If yes please give full details. Include any medication taken currently and details if to be taken during event. (If suffering with a Nut allergy please state requirements for food, i.e. is “May Contain Nuts” food products allowed, etc) *

In the event of minor pain (e.g. headaches), are Leaders permitted to administer Ibuprofen/ Paracetamol via tablet form. Please specify YES or NO to both medications. *

Parents/Carers completing formPlease provide the details of the parent/carer completing this form and giving permission for the young person to partake in the specified activity

Parent/Carer Name *

Contact details during activity *

Relationship to Young Person *

In the event of illness or accident requiring medical treatment, if I cannot be contacted by telephone or other means, I hereby authorise Event Leaders to sign, on my behalf, any written form of consent required by the hospital authorities. *

Please tick the box to confirm you have read and agree.

SIGNED *

Date *

Date Signed