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Mountaineering / climbing course booking form (Adult)
Please note items in bold must be filled out
Course details
Course name:
Date from:
Date to:
Personal details
Name:
Address:
Post code:
E.mail:
Mobile No:
Home No:
Work No:
Date of birth:
Please note any medical conditions that may effect your participation over the duration of the course.
Emergency contact details
Next of kin:
Relationship (parent, partner etc.):
Mobile No:
Home No:
BMC participation Statement
I accept that climbing, hill walking and mountaineering are activities with a danger of personal injury or death. As a participant in these activities I am aware of and accept these risks and therefore I am responsible for my own actions and involvement.
Please read the course booking conditions here before signing and returning this form along with full payment of the course to Rob Keet, 178 Mackie Avenue, Brighton. BN1 8SB. Cheques payable to Touch the Rock.
Signature:
(Type name if submitting electronically)
Date:
If you are submitting this form electronically please note that in the absence of your signature the emailing of this form constitutes your personal certification that the details above are correct.