Moors to Mountains

Parent/Guardian Consent Form

for Children and Young People.

Thank you for booking a place on a Moors to Mountains activity on behalf of a child over the age of fourteen or young person under the age of eighteen in your care.

Please carefully read and complete the following form, which should then be submitted no later than 7 days before the activity. If you have any questions or concerns, you may contact Moors to Mountains via telephone between 10:00 and 20:00 Monday to Friday on 07535489950, by text or Whatsapp any time, or email any time via moorstomountains@gmail.com.

While Moors to Mountains offers a fun, informative and safe environment for all participants, it is important to acknowledge that all outdoor and walking activities present certain risks. A clear safety briefing will be delivered by the walk leader before the booked activity, and on approach to any potential hazards. All Moors to Mountains activities are individually risk assessed and you will have been sent a copy of the risk assessment document for this particular activity by email.

Please refer to the Moors to Mountains Terms & Conditions.

Date of booked activity

Participant (Child or Young Person) Information

Participant Full Name

Please provide forename and surname

Child/young Person relationship to parent/guardian

EG: daughter, grandchild, family friend.

Preferred "nickname"

Please do say if the child/young person would prefer to be addressed more casually

Parent/Guardian Email Address

Please enter your main personal email address

Parent/Guardian Mobile Telephone Number

Please enter your main personal mobile telephone number

Parent/Guardian Home Address

Please supply your home address including house number and postcode

Date of Birth of child/young person

Day

Month

Year

Emergency Contact Information

(Please do not supply details of any other participant on the activity)

Emergency Contact Name

Please provide the name of an emergency contact person for the child/young person - NOT somebody taking part in the activity

Emergency Contact Telephone Number

Relationship of Emergency Contact to child/young person

Participant Medical Information

The following section relates to the personal health, fitness and wellbeing of the child/young person in your care. Please complete all relevant details in as much detail as possible. It is your responsibility as parent/guardian to provide accurate and up-to-date medical information.

If you tick any of the three following boxes, you must provide any details that the walk leader should know in case of a medical or health related incident involving the child/young person in your care during an activity. All details are recorded and stored in confidence for safety reasons. Please see the Moors to Mountains Privacy and Data Storage Policy for further details.

Does the child/young person in your care have any physical or mental health/medical conditions, previous injuries or allergies that may affect their ability to participate in the activity, or which may require sudden treatment during an activity?

Yes

Is the child/young person in your care currently using any medication that the walk leader should be aware of? This includes asthma inhalers, autoinjector pens, blood thinners, weight loss drugs etc.

Yes

Is the child/young person in your care allergic to any medication, or are there any medications or treatments that they would not wish to receive?

Yes

If you have answered "yes" to any of the preceding three questions above, please provide FULL details of anything relevant on behalf of the child/young person in your care, including personal medication, the name and address of their GP or healthcare provider where relevant, if they are taking weight loss drugs or are going to be fasting at the time of the activity. Please also detail any relevant phobias (especially of heights or animals) or conditions such as vertigo. You will be contacted before the activity if any further discussion is required. This information should include all pre-existing medical conditions, previous injuries or special requirements that may affect the participation of the child/young person in your care in this outdoor activity.

If the the child/young person in your care has a pre-existing medical condition or previous injury that may make it unsafe for them to take part in this activity, it is your responsibility as parent/guardian to seek advice from your doctor or a medical specialist before attending.

All participants must bring any personal medication that will or may be needed on any activity, including but not limited to asthma inhalers, autoinjector pens, allergy relief, routine pharmaceuticals and feminine hygiene products.

Details of pre-existing medical conditions or special requirements.

Please provide all relevant information as requested above.

Parent/Guardian Consent Declaration for Children and Young People.

PLEASE CLICK HERE TO READ THE MOORS TO MOUNTAINS PARTICIPANT CONSENT DECLARATION FOR CHILDREN AND YOUNG PEOPLE

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I have read and understand all of the information listed under "Moors to Mountains Parent/Guardian Consent Declaration for Children and Young People". By ticking this box, I agree with and consent to each stipulation as parent/guardian on behalf of the child/young person in my care.

Digital Images and Media Consent Declaration.

During activities, the walk leader will take photographs or video clips of participants and scenery, to be used for publicity and marketing purposes to promote Moors to Mountains via both printed formats and online, including social media platforms.

Your personal choice to be for the child/young person in your care to be included in such media is wholly respected.

Do you consent to the child/young person in your care being included in image or video capture?

Yes, I give my full consent.

No, please do not include the child/young person in my care.

In the event that any participant does not wish to be included in photography or video capture, or that any parent/guardian chooses for the the child/young person in their care not to be included, the walk leader will show discretion and advise the group before any activity to be respectful and only take pictures of themselves and any personal friends. BUT the walk leader cannot be directly responsible for the actions of other participants where taking photos is concerned.

Yes, I agree and understand.

Footwear, Clothing and Equipment Requirements

PLEASE CLICK HERE TO READ THE

MOORS TO MOUNTAINS FOOTWEAR, CLOTHING and EQUIPMENT REQUIREMENTS

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By ticking this box, I confirm that I have read and understand all of the information listed under "Moors to Mountains Footwear, Clothing and Equipment Requirements" on behalf of the child/young person in my care, and hereby agree as parent/guardian that the the child/young person in my care will attend the activity with all necessary items.

On this date, I understand and accept all above consent stipulations in the Moors to Mountains Participation Consent Form for Children and Young People as parent/guardian on behalf of the child/young person in my care

I agree to notify Colin Liptrot if there are changes to any of the supplied information before the date of the booked activity as parent/guardian on behalf of the child/young person in my care.

Parent/Guardian Signature

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