Disclaimer & Medical Consent Form For Under 18s
To be filled out by the Parent/Guardian and presented at Registration for Summer Camp.
The medical information on this form will not be kept once the event has finished.
Please read our
Terms & Conditions and FAQ for more information on participation and health and safety.
I have read and understand the
XTREME.IE Terms & Conditions. The person named below is 7 years of age or older and has my consent to participate in the XTREME.IE activities. I understand that close contact with instructors is necessary whilst being fitted with personal safety equipment or during instruction, a copy of the Company’s Child Protection Policy is available on request. I am also aware that there are minor risks of injury associated with participating in adventure activities but I am also aware that this person will be under qualified supervision at all times and using tested and approved safety systems. Photo Release Form
I, the undersigned, do hereby consent and agree that XTREME.IE have the right to take photographs, or digital recordings of me and all participants of whom I am guardian, while visiting any Xtreme.ie site or participating in their activities. I waive any rights, claims, or interest I may have, to control the use of my identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.
By completing this form I also confirm that I will make XTREME.IE staff aware of any medical condition that the named child may have that may affect his/her involvement with the activities offered. I/We, the Parents/Guardian of the person/s named below, give permission for XTREME.IE staff to administer First Aid and authorise the Company to seek medical attention if required.
Xtreme.ie COVID19 Restrictions
In order for your child to attend Xtreme.ie Camp at Carton House, you must respond positively to each of the below requirements on behalf of the child in which you are the parent/guardian
I confirm that I accept the protocols, terms and conditions of Xtreme.ie Camp
I understand the risks involved and will minimise these risks by following guidelines.
I confirm that I (or my child) am not showing symptoms of COVID-19 (cough, fever, high temperature, sore throat, runny nose, breathlessness or flu-like symptoms) presently nor in the past 14 days.
I confirm that I (or my child) have not come into contact with anyone who has been diagnosed with COVID-19
I confirm that I (or my child) have not been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days, nor have I (or my child) been advised to self-isolate or cocoon at this time.
I acknowledge that the facility has taken measures to minimise the risk but cannot eliminate the risk.
I confirm permission for my data to be used for contact tracing to avoid the spread of COVID-19, with data retained following GDPR guidelines.
Medical Information about Your Child/Child in Your Care (PRIVATE & CONFIDENTIAL) Child's Information * Press + to add more children.
ANY ILLNESS/INJURY REQUIRING MEDICAL TREATMENT OR PRESCRIBED MEDICATION? - If YES, please give brief details.
ANY ALLERGY TO ANY MEDICATION INCLUDING NON-PRESCRIPTIVE MEDICATIONS? - If YES, please give brief details below: Guardian Information Guardian Name *
Relationship to Participant/s * Home Address
* Home Phone Mobile # 1 * Mobile # 2 Email *
Receive info via email on our promotions and new activities * Yes No Consent * I agree to Xtreme.ie Terms & Conditions. * Consent * I have read and understand Xtreme.ie Covid19 restrictions. *