Community Event Registration

UK Community Registration & Medical Form

Choose your trip*
- Gower Climbing Weekend Event
Choose your desired workshop or course*
- Climbing Movement workshop
- Basics of Trad Climbing
- Learning to Lead Trad course
- Intro to Multi-pitch Climbing
- No workshop or course just the general event
Please select 'other' if you desire more than one of the above then list from most to least desired.
PERSONAL INFORMATION
Title (Mr, Mrs, etc.)*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of birth*

DD
MM
YYYY
Age*
As of 19th of February 2017
Home phone
Mobile phone*
E-mail*

NEXT OF KIN
Who we will contact in case of an emergency
Title (Mr, Mrs, etc.)*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home phone
Mobile phone*
Work phone

SPECIAL REQUIREMENTS
Dietary requirements
MEDICAL STATEMENT
Do you, or have you ever had any of the following medical conditions?*
- No current medical conditions
- Diabetes
- Asthma
- Epilepsy
- Heart disease
- Back injuries
- Allergies (food, insect bite, etc.)
- Drug Allergies
- Other
Medical details
If you have stated any conditions above, please provide details here
Medication
If you require medication, please provide details here. N.B. It is your responsibility to bring any medication you need and inform the activity leader of where it is kept.

INSURANCE
The Mountain People is is insured against public liability. If you have taken out a personal policy to cover travel delays, personal injury and loss or damages to possessions, please provide details.
Insurance company
Policy number
Emergency claims number
PHOTOGRAPHY
The Mountain People may post trip photos on its social media for viewing by participants and the public. Occasionally The Mountain People uses photographs taken on trips in its promotional material and website. Please let our staff know on the day if you would not like your image to be used for either of these purposes.
I have read and understood the photography statement*
- Yes
- No
PARTICIPATION STATEMENT
Your attention is brought to the British Mountaineering Council's participation statement: "The BMC recognises that climbing, hill walking and mountaineering are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement."
DISCLAIMER
I accept that The Mountain People is not under any liability whatsoever in respect of loss or damage to personal property not caused by the negligence or default of TMP whilst attending the trip. I have had my attention drawn to the information on insurance cover. Participation in adventurous activities entails some risk of injury. TMP staff are trained and appropriately qualified to run activities and will at all times proceed in a manner to limit the risk of injury. However, participants accept that accidents and injury may occur. If you are not sure of the nature of the risks, please contact us to clarify.
I have read, understood and accept the participation statement and disclaimer*
- Yes
- No
Note
Please note that we are unable to accept you onto this trip, if you have not indicated that you have read and understood the Photography, Participation Statements and Disclaimer. If you have any queries regarding either of the statements, please contact the UK office.
Signed*
Date*
Date Format: DD slash MM slash YYYY
Payment
Thanks for filling in the form; to secure your place we need payment and we will send our bank details and instructions shortly!

Community Event Registration

UK Community Registration & Medical Form

Step 1 of 4

PERSONAL INFORMATION

NEXT OF KIN

SPECIAL REQUIREMENTS

MEDICAL STATEMENT

INSURANCE

PHOTOGRAPHY

PARTICIPATION STATEMENT

DISCLAIMER

Note

Payment