Participant Waiver/ Medical Info

Child First name

Last name

Age /Year Group

Parent / Guardian name

Phone

Address

Adults authorised to pick up child (other than parent/guardian) , will use these as a emergency contact in the event of an emergency and unable to contact parent/ guardian above ( Name / Phone / Relationship)

Is there anyone your child may NOT be picked up by?

Is there anything we should know about your child? ( shyness, low confidence?)

Does your child have any of the following?

Special educational needs?

Allergies?

Medical conditions i.asthma, diabetes, hearing, bone or joint issues?

Other

If ticked above please give information?

I give permission for Nature Beanz Adventures to administer minor first aid treatment to my child in the event of a small injury and I give permission to Nature Beanz Adventures to seek medical treatment for my child in the event of an emergency

I give permission for my child to be photographed

I understand that a charge for late pick -ups after sessions will be charged.

I hereby release and discharge Nature Beanz Adventures, its employees, staff members and administration from any claims, responsibilities or liabilities for injuries or harm incurred as a result of my child’s participation at Nature Beanz Adventures. I authorise Nature Beanz Adventures, its employees, staff and administration to take whatever action necessary, in their best judgement, in an emergency and I hereby release and discharge Nature Beanz Adventures from any responsibility or liability

I have read and acknowledge Nature Beanz Adventures /Education terms and conditions and Behaviour Policy especially our section on serious misconduct towards staff and other participants

Date

Signature

Adventure Outdoor

With Nature Beanz Adventures