MEDICAL AND CONSENT FORM
Name:
DOB:
Trip details (Venue and Date):
Parents contact info
Phone – Mobile:
Home Address:
Home
If not available at the above, an alternative contact is:
Name:
Address:
Doctor’s details:
Name:
Address:
Phone:
Phone:
Medical Information
1: Has your child any medical condition or required and medical attention during the last 3 years?
Yes
No
If yes, please turn over and complete part A.
2: To the best of your knowledge, has your son/daughter been in contact with and contagious or infectious
diseases or suffered from anything in the last four weeks that may become contagious or infectious?
Yes
No
If yes, please complete part B.
3. Does your son/daughter have any prescribed medication?
Yes
No
If yes, please complete part C.
4. Has your son/daughter received a tetanus injection in the last five years?
Yes
No
5. Does your child have any special dietary requirements?
Yes
No
If yes please contact part D.
6. Are there any other conditions that we need to be aware of?
Yes
No
If yes, please complete part E.
Parent or Guardian if under 18 yrs of age.
I agree to my son/daughter taking part in the above mentioned activity and, having read the information sheet, to
participation in the activities described. I support the need for obedience and responsible behaviour. I understand that
photographs may be taken for publicity purposes. I agree to the provision of medical treatment, including anaesthetic, as
considered necessary by the medical authorities present. I understand the extent and limitations of the insurance cover
provided.
I understand to inform the Party Leader/Head as soon as possible of any change in the medical circumstances between
the date signed and the commencement of the visit.
Signed:
Name:
Date:
Hut13 Tilgate Recreation Centre, Tilgate Drive, Crawley, West Susses RH10 5PH
Office 01293552222
Email info@dynamicadventures.co.uk
This side of the form only needs to be completed if you have answered ‘YES’ to one or more of the medical questions
from the medical information.
Part A – Details of medical condition:
Part B - Details of contact with infectious/contagious diseases:
Part C – Details of medication:
Part D – Details of special dietary requirements:
Part E – Any other conditions:
Hut13 Tilgate Recreation Centre, Tilgate Drive, Crawley, West Susses RH10 5PH
Office 01293552222
Email info@dynamicadventures.co.uk
ADVENTUROUS ACTIVITIES INFORMATION
All our courses are run by professional outdoor education teams. All our staff hold current first aid certificates. We do
risk assessments on all our adventure activities. Occasionally however accidents do happen, not only is this the nature
of participating in any ACTIVITY ANYWHERE but it is a part of life.
Mountaineering (including climbing, abseiling, walking, gorge walking and scrambling), Canoe sport, Sailing and our
other Adventurous Activities 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.
The following is a list of examples of the minor accidents / situations that can happen. The list is not exhaustive. If you
don’t wish your child or you to take this type of risk PLEASE DO NOT COME ON THE COURSE!
 Climbing & abseiling – banged knee, slightly scrapped knuckle
 Canoeing & raft building – wet, bruised knee/elbow
 Gorge scrambling – wet, bruised leg, twisted ankle
 Forest adventures/orienteering – nettle stings, insect bites, twigs in face, scratches, twisted ankle
 Mountain walk – twisted ankle,
 Survival training/camping – very minor burns, bruised fingers and many similar issues as listed in forest
adventures.
 Problem solving – splinters, bruised fingers
 GENERAL – if someone slips, whether it’s wet or dry ground, whether they are experienced or not it
occasionally happens, the person may twist an ankle, break a wrist or break a collar bone.
WHO WE ARE AND WHAT WE DO
Dynamic Adventures provide courses, outdoor activities and personal development skills throughout the UK and Europe.
Experience
We have a great deal of experience in working with individuals and cooperatively with schools. Our ever expanding
Duke of Edinburgh Award programme illustrates our ability to safely take large groups of children into wild and
exciting places in the UK and Europe and to provide an enjoyable and educational experience. We have run many
summer activity programmes throughout the country and organise substantial numbers of team building days for
various schools and colleges. We are licensed by the Adventure Activities Licensing Authority
Group Liaison
We will liaise with the organising body or person (coming to visit if appropriate) so that insurance documents, medical
forms and risk assessments have all been dealt with. Often it’s the paper work that impacts most on staff when trying to
organise activities. Dynamic Adventures Ltd designates one person to be your point of contact.
Briefings
Once the group arrive at the location there will be a series of staff and participant briefings both on health and safety
issues and on the activities and logistics. Dynamic risk assessments continue through out the activity making sure staff
and participants are aware of any changes that might be required. The activities are run in accordance with Dynamic
Adventures Ltd operating and emergency procedures and take into account recent legislation and National Governing
Body schemes and procedures. After the activity we will ask everybody to evaluate the day so that we can continually
develop our standard of delivery and safety systems.
For more information on the Adventure Activities Licensing Authority scheme go to www.aala.org.uk
Hut13 Tilgate Recreation Centre, Tilgate Drive, Crawley, West Susses RH10 5PH
Office 01293552222
Email info@dynamicadventures.co.uk