Health & Safety form

Your health, safety and wellbeing is my top priority and I have a duty of care when guiding you out into Nature. I hold a certificate for comprehensive outdoor first aid training and mental health first aid so you can be sure you are in safe hands.

This form is a legal requirement for all events, walks and 1:1 bookings and all information is treated as strictly confidential.

Name

First Name

Last Name

Date of Birth (Please note you need to add month first)

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Number

Date of event you are attending (Please add month first)

YYYY

Emergency Contact Name

First Name

Last Name

Emergency Contact Number

Do you currently have any physical health challenges or conditions including, asthma, joint or mobility problems, high/low blood pressure, diabetes etc? Please list anything even if you feel its minor, its important that I know.

Yes

If you answered Yes to the above question, please give details below. All information will be treated in the strictest confidence.

Do you have emotional or mental health illness or challenges that you feel I should be aware of?

Yes

If you answered Yes to the above question, please give details below. All information will be treated in the strictest confidence.

Please inform me of any illness, condition or operation you have had in the last 5 years

Do you suffer from any allergies including food allergies?

Yes

If you answered yes please give details below

Health & Safety form

HAVE ANY QUESTIONS?

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