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Booking and personal details...

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Medical form

Please fill out our online medical form below.
All information submitted is confidential, you will be emailed a automatic copy once submitted.

  • Booking Details

  • (Please write any previous experiance or aspirations)
  • (If you have particular aims or goals then let us know here)
  • Emergency Contact and Medical details

  • (Please enter any medical condition or old/current injuries that you think might affect the course. All information submitted is confidential. If none please enter "none")
  • (Please provide your insurance details, including policy/membership number)
  • Participation Statements

    (Please read the following section carefully)
  • Terms and conditions:
    I have read, understood and agree to the terms and conditions of booking in particular, cancellation, personal insurance and adverse weather.

  • Consent:
    I agree to authorize Ben Bradford (or associates), during the course/activity to approve such medical treatment as is deemed necessary in an emergency and/or in accordance with the recommendations of a qualified medical practitioner.

  • Participation statement:
    Mountaineering and associated activities, by their nature, involve an element of risk, which cannot be totally eliminated. Every care is taken to ensure the safety and well being of participants. However, adventurous activities do involve the acceptance of risk and of responsibility for the consequences of one’s actions.

  • Verification

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+33 (0) 787371926

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