Child Booking Form for Activities that Take Place in the UK

If the Participant is under 18 years of age then this form needs to be completed by a parent or guardian of the child.

Please tell us your Booking Reference Number:

Please give us the name of your group organiser (lead name):

First name of Participant:

Middle names - If applicable:

Surname:

Date of Birth (dd/mm/yyyy):

Sex (M/F/Other):

Please tell us the height of the participant (important):

Please tell us the weight of the participant (important):

Please tell us the participant's shoe size (important):

Street Name and Number:

City:

County/State/Province:

Postcode:

Country:

Your Name:

Relationship with Participant:

Emergency Contact telephone number:

Alternative emergency telephone number:

Your email address:

Please answer the following 4 questions:

1. Does your child suffer from any medical condition? For example but not limited to; asthma, learning difficulties, epilepsy, allergies etc. (this does not necessarily prevent the child from taking part but we need to be aware):

YesNo

2. Please describe and detail any medical condition your child has and any precautions they need to adhere to (if none, write none):

3. Please list any recent injuries or illnesses (if none, write none):

4. If the child mentioned in this form is required to take any medication please list the name of the medication they take, the required dosages and times it is needed to be taken (if none, write none):

Optional: Additional Information:

By submitting this form you agree to the following 6 statements:

1. Your child participates in the activities provided by Lost Earth Adventures at their own risk. If they feel any pain, dizziness or other problems they should inform their instructor immediately.

2. I understand that Lost Earth Adventures accepts no responsibility for loss, damage, or injury caused by participating in the activities provided by Lost Earth Adventures except where such loss, damage or injury occurred due to the negligence of Lost Earth Adventures.

3. I consent to my child receiving medical treatment that in the opinion of a qualified medical practitioner may be necessary.

4. I consent to my child undergoing First Aid treatment from a member of Lost Earth Adventures staff holding a First Aid Certificate if required.

5. I accept that there is an element of risk involved in the activities that Lost Earth Adventures provides.

6. By submitting this form you are hereby agreeing to the ʻTerms and Conditions of Courses Arranged by Lost Earth Adventures That Take Place in the United Kingdomʼ which is available to view on our website here: Terms and Conditions and confirm that you have read them. Please tick the box if you agree.

Mailing List
If you would like to be sent exclusive deals and details of our new upcoming adventures, please tick this box to be included in our mailing list. We promise to never send you more than 12 emails a year.

If you have any trouble reading the Terms and Conditions or if there is anything about them that you do not understand then you must call us on 01904 500094 and we will be able to send you a copy or explain them to you in more detail. Please do not submit this form until you have read, understood and agreed to our Terms and Conditions.

THIS FORM WILL NOT HAVE SUBMITTED UNLESS YOU HAVE ANSWERED EVERY QUESTION ABOVE. YOU WILL RECEIVE A THANK YOU MESSAGE ONCE IT HAS SUBMITTED SUCCESSFULLY.