Acknowledgement of Risk

We have taken all reasonable steps to provide you with the level of care and assurances of safety appropriate to these activities. However you should be aware that certain inherent risks remain which are integral to the activity, and which cannot be eliminated without destroying the unique character of the activity.

Amongst other things, some of these risks can contribute to:

• the loss or damage of your personal clothing or equipment,
• Feelings of discomfort, fear and apprehension, or even

accidental injury, illness, or trauma.

The level of real (as opposed to apparent) risk associated with the activities of Adventurous Experiences is very low. However, the type of risks may be something with which you are not familiar.

Things you may encounter include, but may not be limited to:

Rough or rugged terrain: Putting greater strain on joints and muscles than you are used to.

Physical effort: All our courses involve physical effort that at times may be more than you are used to. This may involve stamina or physical strength.

Water activities: All normal and appropriate precautions will be taken, such as the use of buoyancy aids when appropriate. However, some situations may become stressful for some people.

Slips and trips. You should be aware that the likelihood of falling over or slipping is likely to be greater than you are used to. Moreover, given the nature of the environment in which these may occur the situation can compound giving rise to a more serious incident.

Adventurous Experiences has clear obligations and responsibilities and we take these very seriously. However, we will be expecting participants to contribute to their own and each other’s safety by following the instructions our staff will, from time to time, be giving you.

Acknowledgement

I recognise & confirm:

• That this course, programme or event may require an attitude and approach different from other activities I have been involved with,
• That the nature of the risks may be different to those which I am familiar with,
• That certain inherent risks remain,
• By signing this I do NOT release Adventurous Experiences from any of its obligations towards me, nor does it affect my legal rights. I have however read and understood the content of this document,
• That Adventurous Experiences may use photographs taken during the course of activities for promotional purposes. When a parent does not agree to their child being photographed, the instructor must be informed and staff will make every effort to comply sensitively.

Signature of Participant (In all cases)                                                   Date              
Signature of Parent of Guardian                                                         Date              

Confidential Health Questionnaire

We are requesting this information to help us provide for better first aid and emergency medical care should that be necessary.  This information is confidential until then.  If there any changes in the condition of your health please let the instructor know.

Are you receiving medical treatment at present?  If so, please give details

Yes / No

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Have you had an operation or any past illnesses or medical conditions we should be aware of? If so, please give details

Yes / No

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Do you suffer from any of the following: Diabetes, Asthma, Epilepsy, or Hay fever, or any other condition that you feel we should be aware of? If yes, please give details:

Yes / No

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(Please make the instructor aware at the beginning of the session if you will be carrying medication or an inhaler.)

Do you have any allergies to drugs, foods, insects or other substances?   If so please give details of the particular allergy and the allergic reaction.

Yes / No

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Do you have any disabilities of back, hips, shoulders, knees or ankles?

Yes / No

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Is there anything else we should know about your physical or emotional condition?

Yes / No

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Other:

Are you able to swim 50 meters? Yes / No …………………………………………...

Declaration

I understand that I will be involved in an activity that requires physical effort and that I need to have a reasonable level of fitness in order to participate. Before commencement of my activity, if I have any concerns whatsoever about my physical fitness or health, I will consult the opinion of my GP immediately. I hereby certify that the above information is to the best of my knowledge true and correct.   I undertake to inform the appointed instructor in charge of the activity in the event of any changes in my health prior to the activity.  

Signed...................................................................Date...........................................