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Participant Information & Consent Form

*Please complete all required fields. Your responses help us ensure your safety and comply with legal requirements.

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Birthday

Day

Month

Year

Emergency Contact Name

Emergency Contact Telephone Number

Relevant Medical Information

Please tell us about any medical conditions, injuries, allergies or other health information that may be relevant to your safety or participation in walks and activities. If there is nothing relevant to declare, please enter “None”.

Consent to Process Health Information

YES

By selecting “Yes”, I explicitly consent to Coast & Country Walking processing the health information I provide for the purpose of helping manage my safety during walks and activities. I understand that relevant information may be shared with emergency services where necessary. I understand that I can withdraw this consent by contacting andy@coastandcountrywalking.com

Participation, Safety & Terms

I have read and agree to the Terms & Conditions

I do not agree

Please read the Coast & Country Walking Terms & Conditions before agreeing below. By selecting “I agree”, you confirm that you have read, understood and agree to the Terms & Conditions, including the sections relating to participation, safety, cancellations and personal responsibility.

Photo & Video Consent

Yes, I consent

No, I do not consent

Photos and videos may be taken during Coast & Country Walking activities and may be used on our website, social media and other promotional material. Please indicate whether you are happy to appear in these images.

By signing below, I confirm that the information I have provided on this form is accurate to the best of my knowledge. I understand that walking and outdoor activities involve inherent risks, and I agree to take reasonable responsibility for my own safety, follow reasonable instructions from the walk leader, and inform Coast & Country Walking of any relevant changes to the information I have provided.

Signature

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