KIT LISTS & FORMS

Personal Details

Your Name (required)

Date of Course (required)

Your Address

Contact Number (required)

Your Email (required)

Date of Birth (required)

Emergency Contact Details

Name (required)

Relationship to client (required)

Emergency Contact Number(s) (required)

Please detail below pre-existing injuries or medical conditions, including allergies,
pregnancy and any medication taken (including over the counter and herbal)

PPE Measurements

Waist size (for harness) (required)

Head circumference (for helmet) (required)

Signed (Type Name) (required)

Signed (Date) (required)

Medical and Consent Form

Participation Statement

PLEASE TICK AS APPROPRIATE (*) AND SIGN AT THE BOTTOM OF THE PAGE

I have read and understood the attached terms and conditions and understand and agree that:

1) Outdoor activities contain an inherent level of risk, mitigated but not eradicated by the actions of an instructor/guide. Please tick.
YesNo

2) I shall endeavour to act in accordance with the instructions of my instructor/guide, and acknowledge that in failing to do so I am directly responsible for my own actions. Please tick.
YesNo

3) I am at a suitable standard of fitness and health to participate in the course I have booked. Please tick.
YesNo

4) In accordance with GDPR regulations, I consent to the data given on this form and during the booking process being held securely and exclusively by Dubh Mor Outdoor. This information will not be passed on to any third parties. Please tick.
YesNo

5) I consent to photographs being taken during the course, and their use on official Dubh Mor social media. Please tick.
YesNo

6) I consent to my social media profiles and mobile number being used for the purposes of group messaging via messenger or Whatsapp – to discuss meeting points etc and share photos after the event. Please tick.
YesNo

7) I hereby grant permission for emergency medical treatment and/or medication to be administered by a qualified medical responder in the event of an accident or injury. Please tick.
YesNo

Signed (Type Name) (required)

Signed (Date) (required)

I consent to having this website store my submitted information for contact purposes. We will not pass on any data to third party people, companies or organisations. Our privacy policy can be viewed in full by clicking Here. Please tick.

Yes

Personal Details

Your Name (required)

Date of Course (required)

Your Address

Contact Number (required)

Your Email (required)

Date of Birth (required)

Emergency Contact Details

Name (required)

Relationship to client (required)

Emergency Contact Number(s) (required)

Please detail below pre-existing injuries or medical conditions, including allergies,
pregnancy and any medication taken (including over the counter and herbal)

PPE Measurements

Waist size (for harness) (required)

Head circumference (for helmet) (required)

Boot Size (for crampons) (required)

Signed (Type Name) (required)

Signed (Date) (required)

Medical and Consent Form

Participation Statement

PLEASE TICK AS APPROPRIATE (*) AND SIGN AT THE BOTTOM OF THE PAGE

I have read and understood the attached terms and conditions and understand and agree that:

1) Outdoor activities contain an inherent level of risk, mitigated but not eradicated by the actions of an instructor/guide. Please tick.
YesNo

2) I shall endeavour to act in accordance with the instructions of my instructor/guide, and acknowledge that in failing to do so I am directly responsible for my own actions. Please tick.
YesNo

3) I am at a suitable standard of fitness and health to participate in the course I have booked. Please tick.
YesNo

4) In accordance with GDPR regulations, I consent to the data given on this form and during the booking process being held securely and exclusively by Dubh Mor Outdoor. This information will not be passed on to any third parties. Please tick.
YesNo

5) I consent to photographs being taken during the course, and their use on official Dubh Mor social media. Please tick.
YesNo

6) I consent to my social media profiles and mobile number being used for the purposes of group messaging via messenger or Whatsapp – to discuss meeting points etc and share photos after the event. Please tick.
YesNo

7) I hereby grant permission for emergency medical treatment and/or medication to be administered by a qualified medical responder in the event of an accident or injury. Please tick.
YesNo

Signed (Type Name) (required)

Signed (Date) (required)

I consent to having this website store my submitted information for contact purposes. We will not pass on any data to third party people, companies or organisations. Our privacy policy can be viewed in full by clicking Here. Please tick.

Yes