School Details

Please fill out the following form to help us understand your physical condition.

Trip Details
ALTERNATIVE EMERGENCY CONTACT
MEDICAL & DIETARY INFORMATION

Your Signature

PRIVACY NOTICE: This form will be kept securely and will be destroyed after 6 months if no incidents occurred during your stay. If an incident has been recorded, we may hold this data for up to 7 years (up to 20 years for U16’s).

Pupil gender breakdown:
Pupil gender breakdown:

BOOKING FORM

We are excited that you will soon be visiting Mount Cook for your adventure! To ensure that we have all the information we need to plan your trip properly, please fill out your details below and one of our team members will be in touch to confirm your next steps.

MEDICAL DISCLAIMER
Individuals must NOT participate in activities if any of the following applies to them. If you have written approval from your doctor, we will need to see this before taking part:
▪ High or low blood pressure, heart disease, other cardiovascular problems including undiagnosed chest pain
▪ Breathing difficulties (including asthma) where it is not satisfactorily controlled by medication
▪ Frequent episodes of feeling faint or dizzy or taking medication which may cause drowsiness
▪ Back pain or limited movement in any joint
▪ Currently pregnant or recently given birth


DECLARATION

▪ I agree to my child taking part in the activities at Mount Cook Adventure Centre and understand that these can never be entirely risk free

▪ I give permission for any medical treatment deemed necessary to be given to ensure my child’s wellbeing

▪ The information I have provided is correct and complete and I will notify Mount Cook if any of this changes prior to arrival

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Mount Cook Activity Limited is a company limited by guarantee registered in England and Wales. 

Company registration number: 08906431  | Registered address: 57 Ashbourne Road, Derby, DE 22 3FS  | VAT registration number: 241628125