Parental Consent Form

Full Name
Email
Address
DOB
Confident in Water?

DOES YOUR CHILD HAVE ANY MEDICAL / PHYSICAL DISABILITY / ILLNESS / ALLERGY? DOES THIS REQUIRE ANY MEDICATION OR TREATMENT? IS HE/SHE LIKELY TO BE AFFECTED BY HEIGHTS / EXPOSURE TO COLD / SUN / WATER ?

No
Yes

Digital Signature Date

Digital Signature Name:
Data Protection Statement

Jacqueline & Edward take privacy seriously and will only use personal information for the purpose(s) for which you have provided it and to ensure our legal and professional obligations to provide safe outdoor adventure experiences.

Personal information pertaining to children under 16 years will be kept on secured servers.

Hard copies of this information is required by Active staff to ensure safe practice is maintained at all times. This information will be destroyed within 30 days of any visit.

We will never share personal information with third parties.

I agree to you using my child’s information for the purposes stated
Date of Experience
Post Code
Name
Height
Shoe Size
I MAY BE CONTACTED BY CALLING THE FOLLOWING NUMBERS.

Telephone 1
Telephone 2

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