Section 1. Applicant

First Name…………………………………………………………………………
Surname……………………………………………………………………………
Address…………………………………………………………………………….
………………………………………………………………………………………
Post Code……….….………………………………………………………………
Tel……..………………………..………Mobile……………………….…..………
Date of Birth……………………………………………………………………….
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. To be completed by Parent or Guardian

Mr/Mrs/Miss/Ms……………………………………………………………………
First Name…………………………………………………………………………
Surname……………………………………………………………………………
Address…………………………………………………………………………….
………………………………………………………………………………………
Post Code…………………………………Tel……………………………………
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 the person named above from taking part in this activity or put themselves or others at risk.
Minors, aged 16 years and below, MUST be accompanied by a responsible adult or competent climber. Under no circumstances can they be left alone without prior arrangement with Boulder UK. Such arrangements will be limited to a maximum stay of 3 hours.
I have read, understood and explained the Boulder UK Guidelines, Conditions of Use and the Boulder UK Participation Statement and give my permission for,
Applicants Name………………………………….………to climb at BoulderUK.
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…………