Gilwell 24 Parent/Guardian Permission Form. Gilwell 24 Parent/Guardian Permission Form

Transcription

1 Gilwell 24 Parent/Guardian Permission Form Participant Name DOB Gilwell 24 Parent/Guardian Permission Form Participant Name DOB Group Name Age (on 06/07/18) Group Name Age (on 06/07/18) I give permission for the above named participant to take part in the following activities which may be on offer. By signing this form, I agree and acknowledge that participants agree to observe safety rules and regulations, and that they take part in activities at their own risk. Scout Adventures does not accept responsibility for any injuries suffered, however caused, or for any accidents resulting in loss or damage to any user of, or visitors to Gilwell Park or their property on or off the premises. Please tick box to agree: Air Rifle Shooting* Laser / Quasar Games Laser Clay Pigeon Shooting Mountain biking Motorised activities (incl. but not limited to: 4x4 activity, quad bikes, tank driving, driving school activity, off-road buggies) * I declare that he/she is not subject to restriction by virtue of Section 21 of the Firearms Act 1968 (which applies only to persons who have served a term of imprisonment or youth custody). Please state if your young person has a disability or condition which may be affected by the activities: I give permission for the above named participant to take part in the following activities which may be on offer. By signing this form, I agree and acknowledge that participants agree to observe safety rules and regulations, and that they take part in activities at their own risk. Scout Adventures does not accept responsibility for any injuries suffered, however caused, or for any accidents resulting in loss or damage to any user of, or visitors to Gilwell Park or their property on or off the premises. Please tick box to agree: Air Rifle Shooting* Laser / Quasar Games Laser Clay Pigeon Shooting Mountain biking Motorised activities (incl. but not limited to: 4x4 activity, quad bikes, tank driving, driving school activity, off-road buggies) * I declare that he/she is not subject to restriction by virtue of Section 21 of the Firearms Act 1968 (which applies only to persons who have served a term of imprisonment or youth custody). Please state if your young person has a disability or condition which may be affected by the activities: Signature of participant: Signature of participant: Name of adult completing this form: Relationship to participant: Name of adult completing this form: Relationship to participant: Signature: Signature: Defaced or corrected forms will not be accepted. A number of other activities at Gilwell 24 require parental/guardian consent. Please ensure that all consent forms are signed and carried during the duration of the event. Without these documents, the young person will be unable to take part in these activities. A signed consent form does not guarantee a place on the activity. GILWELL24.SCOUTS.ORG.UK Defaced or corrected forms will not be accepted. A number of other activities at Gilwell 24 require parental/guardian consent. Please ensure that all consent forms are signed and carried during the duration of the event. Without these documents, the young person will be unable to take part in these activities. A signed consent form does not guarantee a place on the activity. GILWELL24.SCOUTS.ORG.UK

2 Registration Form We will coach you on how to jump and how to land, but the actual act of jumping and landing is something only you can do and we want you to understand this. This is the risk we cannot control or avoid. Before you take part in this leap, we want to be completely clear about this: If you jump and land incorrectly, it could hurt If you do not listen to our instructors and you jump and land incorrectly, it could hurt If you decide to try a flip or other stunt without our permission, it could hurt If you do not think you can adhere to our instructions, please do not take part If you have a medical condition or pre-existing injury which may affect your ability to follow the instructions, or may be made worse by using, please do not take part in this activation First and second names of participant First and second names of parent/guardian or adult responsible today if the participant is under 16 years. Age Sex Male Female Home address or address About the participant (circle or tick the boxes as applicable) The Leap Team use only Have you participated in The Leap before? Yes No Are you under 10 years old, pregnant or over 20 stone in weight? Yes No Have you consumed more than 1.5 units of alcohol in the last six hours? Yes No Have you taken any medication that can affect your judgement or balance? Yes No Have you any existing physical injury or illness that you think may be affected by taking part in The Leap? Yes No Do you want to read the full terms and conditions before participating? Yes No Statement of understanding. I, the participant named above (or I am the parent/guardian/supervising adult of the participant who is under 16); understand the explanation given overleaf (and within the detailed terms and conditions) that while The Leap has taken all reasonable and practicable steps to protect my health and safety (or that of the participant), there can be a risk of injury. acknowledge that the decisions of The Leap team are final, especially if permission is withheld to participate. If this happens, I understand that the motives will be to avoid injury. understand that this activation can be subject to changes in weather conditions and that The Leap team will close the activation if wind measurements are outside of the limits described in The Leap s Method Statement. understand that any decision of the Leap Master regarding my competency to take part in the activation may be based on feedback from other members of the The Leap team and all other relevant facts available at the time. understand that my signature to this document indicates my acceptance of The Leap general terms and conditions, which are available on request. Signature of the participant or their parent/guardian/supervising adult Date

3 LASER - MAYHEM Declaration Laser Mayhem treats the Health and Safety of all participants as a priority. As with any sport/leisure activity there are hazards associated with laser tag. We recommend that old long sleeve trousers and tops are worn with fastened trainers or stout shoes. I understand that: Laser tag is physically and mentally intense and may require extreme exertion to play. The possibility of injury to myself and others exists. The playing area has varying terrain and may be slippery and have many trip hazards There is the possibility of fallen tree debris. No physical contact is allowed between participants I confirm and agree that: I am physically fit and mentally able to take the strain and exertion involved in playing laser tag. I have no medical condition that would prevent me from playing. (Please make the game manager aware if you use an inhaler or any other medical aid) I am fully aware of the risk to myself and others involved in laser tag. I will comply with the rules and use all equipment as instructed and not so as to injure or hurt others. I will obey all instructions from the game manager/site marshals. If after attending the safety talk you do not with to play a full refund will be given to you only. Please print clearly and in CAPITALS Name: Date of Birth / / Address: address:.. Telephone Number.. Post code: Signed:. Date: / / Players under 18 must have this form countersigned by a parent, guardian or organiser All participants must attend our safety talk and adhere to all the site rules. Minimum age year 2 at school. Laser Mayhem may place information about you on our database. Please tick this box if you do not wish to be placed on our database.

4 Date: 15/08/2015 HALE S BOARD AND BIKE PARK MOUNTAINBOARDING AND MOUNTAINBIKING RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT. PLEASE READ CAREFULLY before signing. All participants are required to read this disclaimer before adding their details and signing below before they can participate in any event at Hale s Board and Bike Park. By signing this form, they agree to observe all safety rules and regulations and also agree that they are the only person who knows their level of ability and medical history and agree to immediately inform the staff at Hale s Board and Bike Park of any medical condition that may prohibit or restrict their participation in the sport. Customers with back, knee or asthma problems should think carefully before participating. PARTICIPANTS UNDER 16 will require a parent or guardian to sign on your behalf. If you, as a parent or guardian, are not happy for pictures of your child to be used on our website; please let a member of staff know. All Terrain Boarding, Mountainbiking and the use of dirt scooters can be dangerous for both the riders and spectators alike, and as such no responsibility will be accepted by Hale s Board and Bike Park for injury or accident arising to participants or spectators from use or misuse of the boards, equipment or any other facility provided by the centre in participation of the sports, with the exception of those caused by negligence of Hale s Board and Bike park staff or its representatives. Protective equipment must be worn at all times consisting of a minimum of a Helmet, Knee Pads, Elbow Pads and Wrist Guards when riding a mountain board, riders must also always wear the retention leash at all times to prevent runaway boards or have heel straps attached. Bikes and dirt scooters require a minimum of a helmet. Please be aware that failure to observe these rules may result in eviction from the centre. Please note: The foam pit is only for use by experienced riders, if we feel you do not have the experience to use the pit we reserve the right to stop you. Signature of Participant Name of Participant (Please Print) Address Signature of Parent or Guardian Emergency Contact Name Emergency Contact Phone No.

5 Date: 15/08/2015 Please read previous page and be certain you understand the implications of signing Signature of Participant Name of Participant (Please Print) Address Signature of Parent or Guardian Emergency Contact Name Emergency Contact Phone No.

6 PADI Discover Scuba Diving Participant Statement Please read the following paragraphs carefully and fill in all blanks before signing. This statement, which includes a Medical Questionnaire, Discover Scuba Diving Safe Practices Statement and a Statement of Risks and Liability, informs you of some potential risks involved in scuba diving and of the conduct required of you during the PADI Discover Scuba Diving programme. Your signature is required to participate in the programme. If you are a minor, you must have the Participant Statement (which includes and acknowledges the Medical Questionnaire, the Discover Scuba Diving Safe Practices and the Statement of Risks and Liability) signed by your parent or guardian. You will also need to learn from the instructor the important safety rules regarding breathing and equalisation while scuba diving. Improper use of scuba equipment can result in serious injury or death. You must be thoroughly instructed in its use under the direct supervision of a qualified instructor to use it safely. PADI Medical Questionnaire Scuba diving is an exciting and demanding activity. To scuba dive safely, you must not be extremely overweight or out of condition. Diving can be strenuous under certain conditions. Your respiratory and circulatory systems must be in good health. All body air spaces must be normal and healthy. A person with heart trouble, a current cold or congestion, epilepsy, asthma, a severe medical problem, or who is under the influence of alcohol or drugs, should not dive. If taking medication, consult your doctor before participating in this programme. The purpose of this medical history questionnaire is to find out if you should be examined by a doctor before participating in recreational scuba diving. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a pre-existing condition that may affect your safety while diving and you must seek the advice of a physician. Please answer the following questions on your past and present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your instructor will supply you with a PADI Medical Statement and Guidelines for Recreational Scuba Diver s Physical Examination to take to a physician....do you currently have an ear infection?...do you have a history of ear disease, hearing loss or problems with balance?...do you have a history of ear or sinus surgery?...are you currently suffering from a cold, congestion, sinusitis or bronchitis?...do you have a history of respiratory problems, severe attacks of hayfever or allergies, or lung disease?...have you had a collapsed lung (pneumothorax) or history of chest surgery?...do you have active asthma or history of emphysema or tuberculosis?...are you currently taking medication that carries a warning about any...impairment of your physical or mental abilities?...do you have behavioural health problems or a nervous system disorder?...are you or could you be pregnant?...do you have a history of colostomy?...do you have a history of heart disease or heart attack, heart surgery or blood vessel surgery?...do you have a history of high blood pressure, angina, or take medication to control blood pressure...are you over 45 and have a family history of heart attack or stroke?...do you have a history of bleeding or other blood disorders?...do you have a history of diabetes?...do you have a history of seizures, blackouts or fainting, convulsions or epilepsy or take medications to prevent them?...do you have a history of back, arm or leg problems following an injury, fracture or surgery?...do you have a history of fear of closed or open spaces or panic attacks (claustrophobia or agoraphobia)? Discover Scuba Diving Safe Diving Practices Statement These practices have been compiled for your review and acknowledgment and are intended to increase your comfort and safety in diving. I understand that upon completing the Discover Scuba Diving programme, I will not be qualified to dive independently without a certified professional guiding me. To equalize my ears and sinus air spaces, I will need to blow gently against pinched nostrils every few feet/one metre while descending. If I have discomfort in my ears or sinuses during descent, I should stop my descent and alert my instructor. Underwater, I should breathe slowly, deeply, continuously and never hold my breath. I should respect underwater life and not touch, tease or harass an underwater organism since it may harm me and/or I may harm it. I can seek further training from any PADI Dive Centre, Resort and Instructor to become certified to dive without a professional guide Statement of Risk and Liability (EU Version) I (participant name),, hereby affirm that I am aware that skin and scuba diving have inherent risks which may result in serious injury or death. I affirm I have read and understand the Safe Diving Practices and have had any questions answered to my satisfaction. I understand the importance and purposes of these established practices. I recognise they are for my safety and well being, and that failure to adhere to them can place me in jeopardy when diving. I understand that diving with compressed air involves certain inherent risks; decompression sickness, embolism or other hyperbaric injury can occur that require treatment in a recompression chamber. I further understand that this programme may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. I still choose to proceed with this programme in spite of the absence of a recompression chamber in proximity to the dive site. The information I have provided about my medical history on the Medical Questionnaire is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health conditions. I further understand that skin diving and scuba diving are physically strenuous activities and that I will be exerting myself during this programme. I further state that I am of lawful age and legally competent to sign this Statement of Risks and Liability, or that I have acquired the written consent of my parent or guardian. I understand and agree that neither the dive professionals conducting this programme staff of Orca Scuba Diving Academy, nor the facility through which this programme is conducted, Orca Scuba Diving Academy nor PADI EMEA Ltd., nor PADI Americas, Inc., PADI Worldwide Corp. nor their affiliate or subsidiary corporations, nor any of their respective employees, officers, agents or assigns accept any responsibility for any death, injury or other loss suffered by me to the extent that it result from my own conduct or any matter or condition under my control that amounts to my own contributory negligence. In the absence of any negligence or other breach of duty by the dive professionals conducting this programme staff of Orca Scuba Diving Academy, the facility through which this programme is offered, Orca Scuba Diving Academy PADI EMEA Ltd., PADI Americas, Inc., PADI Worldwide Corp. and all parties referred to above, my participation in this diving programme is entirely at my own risk. I acknowledge receipt of this Statement and have read all of the terms before signing this Statement. Participant Name:... Participant Signature:...Date (Date/Month/Year):... ParenUGuardian Signature (where applicable):...date (Date/Month/Year):... Participant Name:... Participant Signature:...Date (Date/Month/Year):... ParenUGuardian Signature (where applicable):...date (Date/Month/Year):... EMERGENCY CONTACT INFORMATION Name:...Relationship:... Phone: (...)...

7 Non-Agency Disclosure and Acknowledgment Agreement (EU Version) I understand and agree that PAD! Members ( Members ), including Orca Scuba Diving Academy and/or any individual PAD! Instructors and Divemasters associated with the program in which I am participating, are licensed to use various PAD! Trademarks and to conduct PAD! training, but are not agents, employees or franchisees of PAD! EMEA Ltd., PAD! Americas, Inc., or its parent, subsidiary and affiliated corporations ( PADI ). I further understand that Member business activities are independent, and are neither owned nor operated by PAD!, and that while PAD! establishes the standards for PAD! diver training programs, it is not responsible for, nor does it have the right to control, the operation of the Members business activities and the day-to-day conduct of PAD! programs and supervision of divers by the Members or their associated staff. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS NON-AGENCY DISCLOSURE AND ACKNOWLEDGMENT AGREEMENT BY READING IT BEFORE I SIGNED IT. Participant Name:... Discover Scuba Diving Knowledge and Safety Review To continue with your Discover Scuba Diving experience, you must complete this review under the direction of your PADI Professional before getting in the water. 1. Upon completing this experience, I will be qualified to dive independently without a certified professional guiding me. 2. To equalize my ears and sinus air spaces during descent, I will need to blow gently against pinched nostrils. 3. I should equalize every few feeuone metre while descending. 4. If I have discomfort in my ears or sinuses during descent, I should continue downward. 5. Underwater, I should breathe slowly, deeply, continuously and never hold my breath. 6. I should add air to my buoyancy control device (BCD) to float at the surface. 7. The caution zone on my air gauge indicates that I have plenty of air in my tank and that I may continue diving. 8. I should not touch, tease or harass an underwater organism since I may harm it or it may harm me. 9. I should stay close to the PADI Professional during my Discover Scuba Diving experience and signal if something is wrong. Participant Signature:... Date (Date/Month/Year):... Parent/Guardian Signature (where applicable):...date (Date/Month/Year):... Check the appropriate box in response to questions above. True False True False PARTICIPANT INFORMATION : Name:...Program Date (Date/Month/Year):... Participant Statement: I have had this Review explained to me and I now understand any questions I may have answered incorrectly. I acknowledge and accept that these practices are intended to increase my safety and comfort during the experience. Address:... Phone: (...)... Participant Name:... City:...Postcode:...Country:... Participant Signature:... Date (Date/Month/Year):... Birthdate: Flying After Diving Recommendations 1. For single dives within the no decompression limits, a minimum pre-flight surface interval of 12 hours is suggested. 2. For repetitive dives and/or multi-day dives within the no decompression limits, a minimum pre-flight surface interval of 18 hours is suggested. 3. For dives requiring decompression stops, a minimum pre-flight surface interval greater than 18 hours is suggested. 440DT (06/13) Version 2.0

8 THE BIG AIR REVERSE BUNGY DECLARATION Jumpzone Big Air treats the health and safety of all participants as a priority. The BIG AIR is an extreme experience and there are, as with many sports related activities potential hazards. All persons under 18 must seek permission from a parent or guardian prior to using the BIG AIR. I understand that 1 The BIG AIR is an extreme ride 2 The BIG AIR reaches 18 metres in a second 3 All participants must listen to the operator always. 4 The contents of the participant s pockets are emptied. 5 The participant understands this experience can be exhilarating and I accept the associated risks. 6 The jumper should not participate if I m pregnant, drunk, on drugs, unwell, too heavy, already injured. 7 All persons under 18 must seek permission from a parent or guardian. I confirm that 1 I am physically fit and mentally able to experience the speed and height of the BIG AIR 2 I have no medical condition and broken bones 3 I will read the sign displayed at the BIG AIR before taking part in the activity. 4 I will comply with all rules and regulations 5 I will obey all instructions SIGNATURE I, being the parent/guardian of the person named below declare that he/she is allowed to participate on the BIG AIR after reading the above NAME OF CHILD SIGNATURE OF PARENT