Birch Hall Adventures
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Home
Who we are
Our Story
Adventure
Teamwork
Secret Water
Privacy Policy
Get Involved
Support Us
Vacancies
Contact
Adventure Camp
Easter Revision Camp
Camp Instructors/Volunteers
Schools / Groups
Typical Programmes
Activities
Home Educators Programme
Primary Schools
Secondary Schools
Churches
Youth Groups
Adventure Mud Run 2024
Adventure Triathlon
Consent Form
Bunkhouse
Kit Lists
Events & Courses
10 YEARS – BBQ & BARNDANCE
Lent Courses
Climbing Club
Campfire Carols
Follow the Star
Adventure Mud Run 2024
Book Online
Book Online
Booking Conditions
My account
Basket
Consent Form
0
Group Test
Home
Group Test
Please enable JavaScript in your browser to complete this form.
Name of School or Group
*
Date of Visit
*
Date of visit or first day of visit (if multiple days)
Name of child
*
First
Last
Date of Birth
*
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
— Select country —
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Medical Conditions
*
Asthma
Epilepsy
Diabetes
Fainting
Heart conditions
Muscle & Joint conditions
Other (please give details below)
None of the above
Additional Information on Medical Conditions
Medication Taken
Allergies
Dietary Requirements (please include any religious requirements e.g halal)
Other information
NHS Number (if known)
Doctor's Name/ Surgery
Doctor's Telephone
Parent/ Guardian Details
*
First
Last
Mobile Phone (should be contactable in an emergency)
*
Email
*
Communications consent (we do not share your data)
*
I consent to receive communications from Birch Hall Adventures regarding events and activities at the centre
No communications please
Indicate preferred methods below:
*
Telephone
Post
Email
Photographs
I consent to pictures being taken for Birch Hall Adventures news and marketing purposes. Participants will not be named without further consent being obtained.
Consent Statement
*
(To be completed by parent or guardian of participants under 18 years old) I am aware that the activities offered at Birch Hall Adventures are activities with a danger of personal injury or death. I have understood the nature of the activity and accept the risk involved. I confirm I am the parent/guardian of the above-named child and that I consent for him or her to take part in activities at Birch Hall Adventures. I consent to any emergency medical treatment necessary during the events including the administration of anaesthetics.
(To be completed by participants over 18 years old) I am aware that the activities offered at Birch Hall Adventures are activities with a danger of personal injury or death. I have understood the nature of the activity and accept the risk involved. I consent to any emergency medical treatment necessary during the events including the administration of anaesthetics.
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