Consent form

The activity: a guided kayak session on Lough Derg on Saturday 10 May, 10am to 1pm, with qualified instructors. Buoyancy aids are provided. Read it, then tick the lines you agree to; each one is a separate choice.

Participant’s name*

Parent or guardian (if the participant is under 18)

Emergency contact name*

Emergency contact number*

Medical conditions or allergies we should know about

Signature*

Date*