Consent forms must be submitted for Mojo Active Activities

Consent Form

Name of participant *

Date of birth of participant * Day Month Year

Name of parent/carer (If participant is under 18)

Name of organiser e.g. School name, birthday child name, Company or Group name Please be accurate and if in doubt call 01454 660075 to confirm correct input as any error may result in the person not being able to take part.

Date of event * Day Month Year Please ensure you put in the correct date of the activity/party/session as any error may result in the person not being able to take part.

I confirm that the participant is medically fit to participate

Any current medical conditions

Any other relevant information that may affect the attendee's participaton in the event (including dietary or allergy requirements)

Contact Email *

Emergency Contact Number *

We are constantly updating our offering at Mojo Active and frequently run special offers and events which we would like to tell you about in our Mojo Newsletter. Please note, we never pass on your details to 3rd parties.

Please tick if you would like to recieve information on the following Mojo monthly newsletter Children's activities/Holiday club Corporate/Team bulding Muddy madness races and fitness

I accept the terms and conditions of Mojo Active and agree I should abide by the code of conduct while in the care of Mojo Active representatives. I understand that a serious infringement of this code may result in me being prevented from continuing with the activities. I agree to take part in the activities at Mojo Active. Adventurous activities are potentially hazardous with a danger of personal injury. By completing this consent form I am aware and accept these risks and I will be responsible for my own actions and involvement. I understand that Mojo Active holds public liability insurance cover. Mojo Active has an excellent safety record and cannot accept responsibility for injury or illness arising from any of the activities undertaken unless proven negligent. In the unlikely event of injury, I give permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitably qualified medical practitioners

I consent to the above

Do not fill out this field