Hollingworth Lake Adventure & Water Activity Centre Participant Details Form

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Hollingworth Lake Adventure & Water Activity Centre Participant Details Form

First Name(Required)

Surname(Required)

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Phone Number(Required)

Email Address(Required)

Date of Birth(Required)

Medical issues(Required)

Please advice us of any medical issues e.g. asthma, epilepsy, heart conditions etc our instructors will need to be aware of prior to your activity. You can give details of any medication, if the instructor will need to carry it during your activity.

Emergency Contact Details

Name(Required)

Phone Number(Required)

Declaration

Acceptance(Required)

I declare that to the best of my knowledge, I have completed the details in this form correctly.

Please note: Adventurous activities have inherent dangers that cannot be totally negated.

Name(Required)

(Parent or guardian if child is aged under 18).

Today's Date(Required)

Please tick here if you DO NOT want your / your child's photograph taken.

I DO NOT want your / your child's photograph taken.

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