Boulder UK Adult Registration Form

Section 1. Applicant

Mr, Mrs, Miss, Ms…………………………………………………………………
First Name…………………………………………………………………………
Surname……………………………………………………………………………
Address…………………………………………………………………………….
………………………………………………………………………………………
Post Code………………………………………………………………………….
Date of Birth……………………………………………………………………….
Tel………………………………………Mobile…………………………………..
Email………………………………………………………………………………..
Emergency Contact Name……………………………………………………….
Tel…………………………………………………………………………………..

Section 2. Personal Safety

Have you climbed before? Yes / No
If yes, how long have you been climbing?……………………………………...
How often do you climb?………………………………………………………….
Have you used a Bouldering facility before? Yes / No
A Boulder UK member of staff will give you an INDUCTION COURSE.

Section 3. Acknowledgement

I have read and understood the Boulder UK Guidelines, Conditions of Use and the Boulder UK Participation Statement.
I understand that some users of this facility may not be competent climbers and that there is some element of risk.
I know of no medical condition that may prevent me from taking part in this activity or put myself, or others at risk.

Date.………………………………………………………………………………….
Print Name…………………………………………………………………………..
Signature…………………………………………………………………………….

Boulder UK reserves the right to refuse entry or to ask people to leave the premises.

Data Protection Act:
Your information is being stored on a database. From time to time we may send you communications about Boulder UK and companies we are associated with. If you do not wish to receive this information please tick here……………………………