Emergency Contact & Medical Form

Name *

Mobile *

Dates of Event *

Emergency Contact Name *

Please enter the name of who we can contact in an emergency

Emergency Contact Number *

Please enter the number of who we can contact in an emergency

Activity Experience *

Please provide a brief description of the experience you have in the activity you are booked onto. If you are booked onto a ride, it may also be useful to tell us what bike you use.

Dietary Requirements *

List any dietary requirements we need to be aware of.

Medical Conditions *

List any medical conditions or allergies that we need to know about whilst you are on the activity or type nil

Height (Only Required for Bike Hire)

If you are hiring a bike please enter you height here.

I agree to the Terms & Conditions *

YES