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Consent, Medical and Emergency Contact Form

The Course, Event or Expedition that Consent, Medical and Emergency Contact information is being provided
This email address must contain the name of the participant for identity confirmation
This email address must contain the name of the participant legal guardian for identity confirmation
PLEASE BE HONEST WITH YOUR ANSWERS TO HELP US, SHOULD AN EMERGENCY ARISE (All information provided will be treated with the strictest of confidence.)
Can this person be contacted by phone or email in an emergency
Emergency Contact 1 Address during Course, Event or Expedition
The Post Code of Emergency Contact 1 during Course, Event or Expedition
What is the relationship of Emergency Contact 1 relationship to the Participant
A phone number where the emergency contact can be contacted during the normal work hours
A phone number where the emergency contact can be contacted during the night
Mobile phone number for emergency contact 1
Can this person be contacted by phone or email in an emergency
Emergency Contact 2 Address during Course, Event or Expedition
The Post Code of Emergency Contact 2 during Course, Event or Expedition
What is the relationship of Emergency Contact 2 relationship to the Participant
A phone number where the emergency contact can be contacted during the normal work hours
A phone number where the emergency contact 2 can be contacted during the night
Mobile phone number for emergency contact 2
For example: Any long term medical, health or wellbeing issues. Any recent medical, health or wellbeing issues or treatments etc

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  • 2022-23 Programme
  • News
    • Personal paddling development
    • Open Canoe Paddler Events
    • Paddlesport Development Trips
  • Paddlesport Expeditions UK
    • Paddlesport Camping Safari
    • Paddlesport Camping River Wye
    • Canoe Camping Expeditions Scotland
    • Tour of the four
    • Scottish Open Canoe Challenge Expedition.
  • BC Courses and Awards
    • Package Deals
    • Paddlesport Development Trips
    • Leadership Awards
      • British Canoeing Leadership Awards Assessments
      • Paddlesport Leader and Paddlesport Touring Leader
      • Canoe Leader
      • Sea Kayak Leader
    • Coaching
      • Paddlesport Instructor (British Canoeing)
      • Core Coach Training
      • Canoe and Kayak Coach (Sheltered Water)
      • Canoe Coach (Moderate Water)
      • Open Canoe Coaching
    • British Canoeing Personal Performance Awards
    • Safety & Rescue
      • British Canoeing Coastal Navigation and Tidal Planning course
    • British Canoeing Guide Endorsement Scheme.
      • What is a British Canoeing Endorsed Guide
      • How to Become a British Canoeing Guide
      • British Canoeing Online Guide Modules
      • Camp Craft and Expedition Skills British Canoeing Guide Module
      • Paddlesport Guide Development and CPD
  • Personal paddling development
    • Open Canoe Coaching
    • Paddlesport Development Trips
  • This Girl Can
  • Safeguarding
  • First Aid
  • WithDave DofE Expedition
  • Library
    • Useful Documents
    • Videos and Photo’s
    • 2021 Programme
    • WithDave Paddle Chat
    • Consent, Medical and Emergency Contact Form
    • Participants Profile Form
  • About Us
    • The WithDave Team
  • Contact
    • Contact us
    • Booking Form
    • Application Form
    • DofE Expedition Application Form
    • Contact Form
  • The Dave’s Top Tip’s and Endorsements
  • Open Canoe Paddler Events
  • Facebook
  • Instagram