Event Registration Form / Health Declaration Form

Name*

First NameLast Name

Email*

example@example.com

Phone number *

Postcode*

Date of birth:*

Date

Gender*

MaleFemalePrefer not to say

Level of fitness *

Emergency Contact Name: *

First NameLast Name

Emergency Contact Phone:*

Do you have any DIAGNOSED health conditions, this is mental or physical health conditions, disabilities, impairments. By ticking box make an absolute declaration that your answer is true and to the best of your knowledge. We will not / cannot be held liable if your answer provided is wrong.*

YesNo

If yes to the above, please list the conditions:

Are you on any PRESCRIBED or NON PRESCRIBED Medication, this for any mental or physical health conditions, disabilities or impairments. By ticking the box you make an absolute declaration that your answer is true and to the best of your knowledge. We will not / cannot be held liable if your answer provided is not true.*

YesNo

If yes to the above, please list the medication:

By signing and completing this form, you are agree to the following waiver

DETAILS OF ACTIVITY
1. The Participant will be participating in The Leg Up Project outdoor activities:

2. (the "Activity") provided by the Activity Provider.

Being of lawful age and in consideration of being permitted to participate in the Activity, the Participant releases and forever discharges the Activity Provider, its owners, directors, officers, employees, agents, assigns, legal representatives, and successors from all manner of actions, causes of action, debts, accounts, bonds, contracts, claims, and demands for or by reason of any injury to person or property, including injury resulting in the death of the Participant, which has been or may be sustained as a consequence of the Participant's participation in the Activity, and not withstanding that such damage, loss, or injury may have been caused solely or partly by the negligence of the Activity Provider.

The Participant understands that the Participant would not be permitted to participate in the Activity unless the Participant signed this Waiver.

5. The Participant acknowledges that this Waiver is given with the express intention of effecting the extinguishment of certain obligations owed to the Participant by the Activity Provider, and with the intention of binding the Participant's spouse, heirs, executors, administrators, legal representatives, and assigns.

FITNESS TO PARTICIPATE

6. The Participant acknowledges to the Activity Provider that the Participant does not have any physical limitations, medical ailments, or physical or mental disabilities that would limit or prevent the Participant from participating in the Activity. If required, the Participant will obtain a medical examination and clearance.

FULL AND FINAL SETTLEMENT

7. The Participant acknowledges and agrees with the Activity Provider that: (1) the Activity Provider has given the Participant sufficient time to carefully read this Waiver,

(2) the Participant has been given the opportunity and has been encouraged to seek independent legal advice prior to signing this Waiver,

(3) the Participant fully understands the risks and claims that the Participant is waiving to participate in the Activity,

(4) the Participant is freely and voluntarily executing this Waiver, and

(5) the Participant is forever prevented from suing or otherwise claiming against the Activity Provider for any property loss or personal injury that the Participant may sustain while participating in or preparing for the Activity.

GOVERNING LAW
8. This Waiver will be governed by and construed in accordance with the laws of the Country of England.

If you fail to provide, provide wrong information or do not update us with the correct information as it changes, we will not be held liable for any action that is resulted from this.

By ticking this box, I declare that the contents of this document is the truth and full truth and to the best of my knowledge and will update The Leg Up Project CIC if any of the information or answers change.*

I ACCEPT