top of page
lake.jpg

When booking any activity directly with Ian Brotherton Mountain Leader, please complete and submit the Medical Declaration and Informed Consent Declaration below.

PART 1: Your details

PART 2: Medical Declaration

1. Do you have any medical conditions or allergies that we should be aware of, which may affect your ability to participate, or which may require sudden treatment during your course?
2. Are you currently taking any medication which we should be aware of?
3. Are you allergic to any medication, or are there any medications or treatments that you would not wish to receive?

PART 3: Informed Consent

Please read the following statements carefully and select either Agree or Disagree

I realise and accept that mountain training, walking and wild camping are activities which carry a danger of personal injury as they take place in hill and mountain terrain. I am aware of and accept these risks and will be responsible for my own actions and involvement in such activities.  

​

While on an activity and in the care of Ian Brotherton Mountain Leader instructors, I agree to abide by any instructions and decisions made by the instructor regarding individuals and the group as a whole. If I choose to disregard any advice given by Ian Brotherton Mountain Leader instructors before, during or after the activity, I do so voluntarily and accept liability for all resulting injuries or damage. 

​

I consent to actions being taken including emergency first aid treatment being provided with the best of intention by any qualified staff or medical professionals. I understand that the staff will make every effort to contact me and my emergency contact as soon as reasonably possible regarding any incidents and such treatment.

​

While on the activity and in the care of Ian Brotherton Mountain Leader instructors, I agree to abide by any instructions and decisions made by the instructor regarding individuals and the group as a whole. If I choose to disregard any advice given by Ian Brotherton Mountain Leader before, during or after the activity, I do so voluntarily and accept liability for all resulting injuries or damage. â€‹

I understand and agree to all statements above.
I understand that Ian Brotherton Mountain Leader accepts no responsibility for accidents or injury to participants or for loss of or damage to personal effects, unless caused by negligence on the part of Ian Brotherton Mountain Leader and its instructors
During the course of our activities, Ian Brotherton Mountain Leader may take photographs. These photographs may be used for publicity and marketing purposes in the future. Please check the box below if you are happy for your photograph to be taken.
General Data Protection Regulation. I would like Ian Brotherton Mountain Leader to contact me in future about other courses and I consent to my personal details being kept for that purpose. I understand that I can change my mind at any time by notifying Ian Brotherton Mountain Leader by email. *

PART 4: Forms Submission

Please submit the above forms by clicking the button below.

Thanks for submitting!

bottom of page