Are you undergoing any medical treatment or do you have any illness, allergy or disability? NoYes - If yes, please give details below

Please summarise previous experience of your chosen activity:

Please tick which of the following equipment you need us to provide

Any Special Requirements for Accommodation

We can provide a packed lunch at an extra cost of �per lunch.

Any Special Requirements for Packed Lunch

The Course fee is £0, subject to confirmation.

In the box below enter the course fee + cost of shoes + cost of lunches.

If you are printing and posting this form, please sign. If you are submitting online, please tick the box to agree to terms and conditions

I understand that this is a provisional booking and once a place has been confirmed, I will pay a deposit of 40% of the full fee to Dringo Adventure. This is non refundable, unless the course is cancelled by Dringo Adventure.I accept that mountain activities and sports are hazardous by their nature. I understand that Dringo Adventure staff are appropriately qualified and experienced to run the activity and will at all times proceed in a manner to limit the risk of injury, and I accept that accidents and injury may occur.I confirm I have read and understood the booking terms and conditions and that I agree to accept and abide by them.

Signed : (If under 18 a parent or guardian must also sign)Dated :