Plas Menai National Outdoor Centre

Guest Registration Form / Acknowledgement of Risk

Booking information

PLEASE NOTE: Here we require the information of the person who made the booking online.
Participant details to be entered further down the form.
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Emergency Contact

Participant 1

1. In the unlikely event of an accident, loss, or damage to my personal effects, I acknowledge that Plas Menai will not be liable for any direct or indirect loss, damage or injury arising from the centre and facilities (except for death or personal injury caused by the Company’s negligence) and I will waive all and any claims against the Company in this respect.

2. I agree that I comply with all health and safety policies and procedures, and other instructions given by the Centre and its duly authorised staff, including those relating to fire and evacuation.

3. I acknowledge that this Acknowledgement of Risk and Conditions of Participation applies to all activities I’m taking part in at Plas Menai.

4. I confirmthat I am over 18 years old.

5. I agree that I the named participant will undertake the activity/activities in accordance with the specific oral and written instructions and advice given before and/or during the activity/activities, failure to do so may result in serious injury or death. I acknowledge clause 11 of Sport Wales’ booking terms and conditions relating to unruly behaviour. These are available at www.plasmenai.co.uk/terms

6. I confirm to the best of my knowledge that I have no undisclosed medical condition which is likely to increase the chance of being involved in an incident, resulting in injury to myself or others. I acknowledge that Sport Wales reserves the right to refuse to allow participation in certain activities if a declared medical or other condition is considered detrimental to the safety or smooth running of those activities.

7. I understand and accept that the nature of the activities may result in damage to clothing. *

Please tick the below, If you are in doubt or you have demonstrated any of the symptoms listed below, please do not attend your session, please email us at Plasmenai.bookings@sport.wales  In this instance you will be offered a refund or the opportunity to move your session to another date.

1. I do not currently have symptoms of COVID-19 (new persistent dry cough, fever, loss of taste or smell)

2. I have not had a positive test for COVID-19 or onset of symptoms of COVID-19 in the last 10 days.  (Individuals who have completed their period of isolation (10 days) and have no remaining symptoms (other than a dry cough or loss of taste or smell which can last for some time) may return to normal activities)

3. No member of my household has had symptoms of COVID-19 or has tested positive for COVID-19 in the last 14 days

4. I have not returned from a country outside of the UK in the last 14 days, other than those on the exempt list https://gov.wales/exemptions-self-isolation-coronavirus-covid-19-html

5. I have not been contacted by a contact tracer from the Test, Trace and Protect Programme and told to isolate in the last 14 days as a contact of someone with confirmed COVID *
Activity Participant 18 years + Please sign and date this form if you wish to take part in the activities at Plas Menai on the terms of this form. Signature Required *
clear

Participant 2

1. In the unlikely event of an accident, loss, or damage to my personal effects, I acknowledge that Plas Menai will not be liable for any direct or indirect loss, damage or injury arising from the centre and facilities (except for death or personal injury caused by the Company’s negligence) and I will waive all and any claims against the Company in this respect.

2. I agree that I comply with all health and safety policies and procedures, and other instructions given by the Centre and its duly authorised staff, including those relating to fire and evacuation.

3. I acknowledge that this Acknowledgement of Risk and Conditions of Participation applies to all activities I’m taking part in at Plas Menai.

4. I confirmthat I am over 18 years old.

5. I agree that I the named participant will undertake the activity/activities in accordance with the specific oral and written instructions and advice given before and/or during the activity/activities, failure to do so may result in serious injury or death. I acknowledge clause 11 of Sport Wales’ booking terms and conditions relating to unruly behaviour. These are available at www.plasmenai.co.uk/terms

6. I confirm to the best of my knowledge that I have no undisclosed medical condition which is likely to increase the chance of being involved in an incident, resulting in injury to myself or others. I acknowledge that Sport Wales reserves the right to refuse to allow participation in certain activities if a declared medical or other condition is considered detrimental to the safety or smooth running of those activities.

7. I understand and accept that the nature of the activities may result in damage to clothing. *

Please tick the below, If you are in doubt or you have demonstrated any of the symptoms listed below, please do not attend your session, please email us at Plasmenai.bookings@sport.wales  In this instance you will be offered a refund or the opportunity to move your session to another date.

1. I do not currently have symptoms of COVID-19 (new persistent dry cough, fever, loss of taste or smell)

2. I have not had a positive test for COVID-19 or onset of symptoms of COVID-19 in the last 10 days.  (Individuals who have completed their period of isolation (10 days) and have no remaining symptoms (other than a dry cough or loss of taste or smell which can last for some time) may return to normal activities)

3. No member of my household has had symptoms of COVID-19 or has tested positive for COVID-19 in the last 14 days

4. I have not returned from a country outside of the UK in the last 14 days, other than those on the exempt list https://gov.wales/exemptions-self-isolation-coronavirus-covid-19-html

5. I have not been contacted by a contact tracer from the Test, Trace and Protect Programme and told to isolate in the last 14 days as a contact of someone with confirmed COVID
Activity Participant 18 years + Please sign and date this form if you wish to take part in the activities at Plas Menai on the terms of this form. Signature Required *
clear

Participant 3

1. In the unlikely event of an accident, loss, or damage to my personal effects, I acknowledge that Plas Menai will not be liable for any direct or indirect loss, damage or injury arising from the centre and facilities (except for death or personal injury caused by the Company’s negligence) and I will waive all and any claims against the Company in this respect.

2. I agree that I comply with all health and safety policies and procedures, and other instructions given by the Centre and its duly authorised staff, including those relating to fire and evacuation.

3. I acknowledge that this Acknowledgement of Risk and Conditions of Participation applies to all activities I’m taking part in at Plas Menai.

4. I confirmthat I am over 18 years old.

5. I agree that I the named participant will undertake the activity/activities in accordance with the specific oral and written instructions and advice given before and/or during the activity/activities, failure to do so may result in serious injury or death. I acknowledge clause 11 of Sport Wales’ booking terms and conditions relating to unruly behaviour. These are available at www.plasmenai.co.uk/terms

6. I confirm to the best of my knowledge that I have no undisclosed medical condition which is likely to increase the chance of being involved in an incident, resulting in injury to myself or others. I acknowledge that Sport Wales reserves the right to refuse to allow participation in certain activities if a declared medical or other condition is considered detrimental to the safety or smooth running of those activities.

7. I understand and accept that the nature of the activities may result in damage to clothing. *

Please tick the below, If you are in doubt or you have demonstrated any of the symptoms listed below, please do not attend your session, please email us at Plasmenai.bookings@sport.wales  In this instance you will be offered a refund or the opportunity to move your session to another date.

1. I do not currently have symptoms of COVID-19 (new persistent dry cough, fever, loss of taste or smell)

2. I have not had a positive test for COVID-19 or onset of symptoms of COVID-19 in the last 10 days.  (Individuals who have completed their period of isolation (10 days) and have no remaining symptoms (other than a dry cough or loss of taste or smell which can last for some time) may return to normal activities)

3. No member of my household has had symptoms of COVID-19 or has tested positive for COVID-19 in the last 14 days

4. I have not returned from a country outside of the UK in the last 14 days, other than those on the exempt list https://gov.wales/exemptions-self-isolation-coronavirus-covid-19-html

5. I have not been contacted by a contact tracer from the Test, Trace and Protect Programme and told to isolate in the last 14 days as a contact of someone with confirmed COVID
Activity Participant 18 years + Please sign and date this form if you wish to take part in the activities at Plas Menai on the terms of this form. Signature Required *
clear

Participant 4

1. In the unlikely event of an accident, loss, or damage to my personal effects, I acknowledge that Plas Menai will not be liable for any direct or indirect loss, damage or injury arising from the centre and facilities (except for death or personal injury caused by the Company’s negligence) and I will waive all and any claims against the Company in this respect.

2. I agree that I comply with all health and safety policies and procedures, and other instructions given by the Centre and its duly authorised staff, including those relating to fire and evacuation.

3. I acknowledge that this Acknowledgement of Risk and Conditions of Participation applies to all activities I’m taking part in at Plas Menai.

4. I confirmthat I am over 18 years old.

5. I agree that I the named participant will undertake the activity/activities in accordance with the specific oral and written instructions and advice given before and/or during the activity/activities, failure to do so may result in serious injury or death. I acknowledge clause 11 of Sport Wales’ booking terms and conditions relating to unruly behaviour. These are available at www.plasmenai.co.uk/terms

6. I confirm to the best of my knowledge that I have no undisclosed medical condition which is likely to increase the chance of being involved in an incident, resulting in injury to myself or others. I acknowledge that Sport Wales reserves the right to refuse to allow participation in certain activities if a declared medical or other condition is considered detrimental to the safety or smooth running of those activities.

7. I understand and accept that the nature of the activities may result in damage to clothing. *

Please tick the below, If you are in doubt or you have demonstrated any of the symptoms listed below, please do not attend your session, please email us at Plasmenai.bookings@sport.wales  In this instance you will be offered a refund or the opportunity to move your session to another date.

1. I do not currently have symptoms of COVID-19 (new persistent dry cough, fever, loss of taste or smell)

2. I have not had a positive test for COVID-19 or onset of symptoms of COVID-19 in the last 10 days.  (Individuals who have completed their period of isolation (10 days) and have no remaining symptoms (other than a dry cough or loss of taste or smell which can last for some time) may return to normal activities)

3. No member of my household has had symptoms of COVID-19 or has tested positive for COVID-19 in the last 14 days

4. I have not returned from a country outside of the UK in the last 14 days, other than those on the exempt list https://gov.wales/exemptions-self-isolation-coronavirus-covid-19-html

5. I have not been contacted by a contact tracer from the Test, Trace and Protect Programme and told to isolate in the last 14 days as a contact of someone with confirmed COVID
Activity Participant 18 years + Please sign and date this form if you wish to take part in the activities at Plas Menai on the terms of this form. Signature Required *
clear

Participant 5

1. In the unlikely event of an accident, loss, or damage to my personal effects, I acknowledge that Plas Menai will not be liable for any direct or indirect loss, damage or injury arising from the centre and facilities (except for death or personal injury caused by the Company’s negligence) and I will waive all and any claims against the Company in this respect.

2. I agree that I comply with all health and safety policies and procedures, and other instructions given by the Centre and its duly authorised staff, including those relating to fire and evacuation.

3. I acknowledge that this Acknowledgement of Risk and Conditions of Participation applies to all activities I’m taking part in at Plas Menai.

4. I confirmthat I am over 18 years old.

5. I agree that I the named participant will undertake the activity/activities in accordance with the specific oral and written instructions and advice given before and/or during the activity/activities, failure to do so may result in serious injury or death. I acknowledge clause 11 of Sport Wales’ booking terms and conditions relating to unruly behaviour. These are available at www.plasmenai.co.uk/terms

6. I confirm to the best of my knowledge that I have no undisclosed medical condition which is likely to increase the chance of being involved in an incident, resulting in injury to myself or others. I acknowledge that Sport Wales reserves the right to refuse to allow participation in certain activities if a declared medical or other condition is considered detrimental to the safety or smooth running of those activities.

7. I understand and accept that the nature of the activities may result in damage to clothing. *

Please tick the below, If you are in doubt or you have demonstrated any of the symptoms listed below, please do not attend your session, please email us at Plasmenai.bookings@sport.wales  In this instance you will be offered a refund or the opportunity to move your session to another date.

1. I do not currently have symptoms of COVID-19 (new persistent dry cough, fever, loss of taste or smell)

2. I have not had a positive test for COVID-19 or onset of symptoms of COVID-19 in the last 10 days.  (Individuals who have completed their period of isolation (10 days) and have no remaining symptoms (other than a dry cough or loss of taste or smell which can last for some time) may return to normal activities)

3. No member of my household has had symptoms of COVID-19 or has tested positive for COVID-19 in the last 14 days

4. I have not returned from a country outside of the UK in the last 14 days, other than those on the exempt list https://gov.wales/exemptions-self-isolation-coronavirus-covid-19-html

5. I have not been contacted by a contact tracer from the Test, Trace and Protect Programme and told to isolate in the last 14 days as a contact of someone with confirmed COVID
Activity Participant 18 years + Please sign and date this form if you wish to take part in the activities at Plas Menai on the terms of this form. Signature Required *
clear

Participant 6

1. In the unlikely event of an accident, loss, or damage to my personal effects, I acknowledge that Plas Menai will not be liable for any direct or indirect loss, damage or injury arising from the centre and facilities (except for death or personal injury caused by the Company’s negligence) and I will waive all and any claims against the Company in this respect.

2. I agree that I comply with all health and safety policies and procedures, and other instructions given by the Centre and its duly authorised staff, including those relating to fire and evacuation.

3. I acknowledge that this Acknowledgement of Risk and Conditions of Participation applies to all activities I’m taking part in at Plas Menai.

4. I confirmthat I am over 18 years old.

5. I agree that I the named participant will undertake the activity/activities in accordance with the specific oral and written instructions and advice given before and/or during the activity/activities, failure to do so may result in serious injury or death. I acknowledge clause 11 of Sport Wales’ booking terms and conditions relating to unruly behaviour. These are available at www.plasmenai.co.uk/terms

6. I confirm to the best of my knowledge that I have no undisclosed medical condition which is likely to increase the chance of being involved in an incident, resulting in injury to myself or others. I acknowledge that Sport Wales reserves the right to refuse to allow participation in certain activities if a declared medical or other condition is considered detrimental to the safety or smooth running of those activities.

7. I understand and accept that the nature of the activities may result in damage to clothing. *

Please tick the below, If you are in doubt or you have demonstrated any of the symptoms listed below, please do not attend your session, please email us at Plasmenai.bookings@sport.wales  In this instance you will be offered a refund or the opportunity to move your session to another date.

1. I do not currently have symptoms of COVID-19 (new persistent dry cough, fever, loss of taste or smell)

2. I have not had a positive test for COVID-19 or onset of symptoms of COVID-19 in the last 10 days.  (Individuals who have completed their period of isolation (10 days) and have no remaining symptoms (other than a dry cough or loss of taste or smell which can last for some time) may return to normal activities)

3. No member of my household has had symptoms of COVID-19 or has tested positive for COVID-19 in the last 14 days

4. I have not returned from a country outside of the UK in the last 14 days, other than those on the exempt list https://gov.wales/exemptions-self-isolation-coronavirus-covid-19-html

5. I have not been contacted by a contact tracer from the Test, Trace and Protect Programme and told to isolate in the last 14 days as a contact of someone with confirmed COVID
Activity Participant 18 years + Please sign and date this form if you wish to take part in the activities at Plas Menai on the terms of this form. Signature Required *
clear

Under 18s

1. I acknowledge that this Acknowledgement of Risk and Conditions of Participation applies to all activities the named participant above is taking part in at Plas Menai.

2. I declare that I am over 18 years old.

3. I consent to allow the named participant to participate. I acknowledge that they will be involved in adventurous or strenuous activity and accept that there are risks in doing so. I will ensure they comply with the conditions of participation detailed in this form and in the Plas Menai Booking terms and conditions which are incorporated into this form and can be found at www.plasmenai.co.uk/terms I confirm they are at least the minimum age of 8 and that the proposed activities are within his/her abilities.

4. I agree that that the named participant will undertake the activity/activities in accordance with the specific oral and written instructions and advice given to them before and/or during the activity/activities, failure to do so may result in serious injury or death. I acknowledge clause 11 of Sport Wales’ booking terms and conditions relating to unruly behaviour. These are available at www.plasmenai.co.uk/terms

5. I declare that to the best of my knowledge the named participant does not have a medical condition which is likely to increase the chance of being involved in an incident, resulting in injury to themself or others. I shall make Sport Wales aware of any injury or illness that occurs between the date on this form and the date of the proposed trip. I acknowledge that Sport Wales reserves the right to refuse to allow the named participant to take part in certain activities if a declared medical or other condition is considered detrimental to the safety or smooth running of those activities.

6. I understand and accept that the nature of the activities may result in damage to clothing.

7. Participants are expected to be responsible for their own belongings. In the event of an accident involving the named participant, or loss, or damage to his/her personal effects, I acknowledge that Sport Wales will not be liable for any direct or indirect loss, damage or injury arising from or in connection with the Activity/Activities (except for death or personal injury caused by the negligence of Sport Wales) and I will waive all and any claims against Sport Wales in this respect. *
Please sign and date if you agree with the above *
clear

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