Name *

First Name

Last Name

Phone *

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have any existing medical conditions that I should be aware of that may impact your participation, or may require sudden treatment during the session? *

e.g. asthma, sore knees, heart condition, epilepsy, allergies etc.

Yes (if yes, please provide details below)

No

Are you currently taking any medication that I should be aware of? *

E.g. for a heart condition, asthma inhaler etc.

Yes (please list below)

No

Are you allergic to any medication, or are there any medication or treatments you do not wish to receive? *

Yes (please provide details below)

No

Medical Declaration *

I consider myself to be fit and in good health, there is no medical reason why I should not participate in activities offered by Vanessa Bear. In the event of an accident during my activity, I give full permission for the relevant instructors, who are suitably trained in First Aid, to administer whatever First Aid treatment they deem appropriate under the circumstances (except as listed above).

Agree

Statement of activity risk *

I accept that yoga, movement, hill and mountain walking and bushcraft/ forest school activities carry a danger of personal injury. I am aware of and accept these risks and will be responsible for my own personal actions in such activities. As a participant in these activities I am aware of and accept these risks and I am responsible for my own actions. I undertake to not be under the influence of alcohol or other drugs that may impair my ability to safely take part in this activity. Vanessa Bear 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 Vanessa Bear. While on the event/ workshop and in the care of Vanessa Bear facilitators/ 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 Vanessa Bear before, during or after the course, I do so voluntarily and accept liability for all resulting injuries or damage. While attending Vanessa Bear's events, I agree to abide by any instructions and decisions made by the instructor (whether that's individuals and/or the group as a whole. If I choose to disregard any advice given by Vanessa Bear before, during or after the course, I do so voluntarily and accept liability for all resulting injuries or damage. I understand that Vanessa Bear accepts no responsibility for damage or loss of personal possessions on the event and also any accidents or injury to participants or for loss of or damage to personal effects, unless caused by negligence on the part of Vanessa Bear.

I agree

Statement of physical activity *

I consider myself fit and able to take part in this activity. I am responsible for my personal fitness and take responsibility for deciding whether the activity is appropriate for me.

I agree

Photo + film footage *

During the events/ workshops we may take photos and films of the event. These may be used on our social media channels and/or our website. If you'd prefer not to have photos/videos taken on the day please let us know below.

I agree

I disagree

GDPR

I would like Vanessa Bear to inform me about future workshops 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 Vanessa Bear by email

I consent

I do not consent

Terms and Conditions *

Please read the terms and conditions of the workshop/ event and check the box below to confirm you have read and understood: https://wildandwellbeing.com/tcworkshopsevents

I have read and understood the terms and conditions

Emergency contact phone number *

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