Junior Taster Form – Activate Waterford

JUNIOR Taster Session

SUPERVISED Junior Climber Registration Form
To be used for ALL individual young people under 18 years when being supervised by ACTIVATE Instructors. Please complete ALL Sections

Date Attending*

Young Climber Details

Young Person Details*

First	Last	D.O.B.

By selecting YES, As Parent/Guardian I can confirm that all climbers are under 120KG (19 Stone) AUTO BELAY LIMIT 120 Kg*

Yes
No

As the legal Parent/Guardianof the above named children, Please select "YES" below if you have READ, UNDERSTOOD & ACCEPT the information and warnings printed underneath.*

Yes
No

Important Information for Parents/Guardians.
Mountaineering Ireland issues the following advice to those participating in any climbing activity.
Climbing is an activity with a risk of personal injury and/or death.
As the parent/guardian of the person(s) named on this form you must indicate that you understand and accept that your child/ward will be exposed to these risks whilst engaged in climbing activities.
Do not use any ACTIVATE facilities if you are unwilling for your child/ward to be exposed to these risks.
ACTIAVTE will provide appropriate supervision and conform to Governing Body recommendations; however the nature of these activities means that your child/ward may not be under direct supervision at all times whilst engaged in climbing activities. You should read and discuss ACTIVATE’s climbing center ………………………………………………………….

Details of any medical conditions of any of the climbers

Yes

Please give details about medicalconditions

Parent/Guardian Contact Details

Name*

First

Last

Phone*

Email*

Consent

I have understood the Conditions of Entry to the Premises and its activities and have explained same to the child/ren for whom I am responsible.*

I have understood the Conditions of Entry to the Premises and have explained same to the child/ren for whom I am responsible.

I agree that I and the child/ren for whom I am responsible will abide by and are bound by all conditions of entry as set out above.*

I agree that I and the child/ren for whom I am responsible will abide by and are bound by all conditions of entry as set out above.

Privacy Policy*

I agree to the privacy policy.*

Signature of Parent/Responsible Adult*

CAPTCHA

Email

This field is for validation purposes and should be left unchanged.