Name: Transfer Course Registration
SKU: 3747
Price: 50.00 NZD
Availability: InStock

Name*

First Last

Date of birth*

Email*

Mobile phone number*

Address*

Street Address Address Line 2 City State / Province / Region Postal Code Country

Emergency contact information

Emergency contact name*

First Last

Emergency contact number*

Relationship to you*

Medical history and information

Allergies*

Are you allergic to any medicines (i.e. penicillin, aspirin, sulfa), foods (i.e. peanuts), insect bites (i.e.bees) or other substances (i.e. dust)?

Yes
No

Please describe your allergies

Medical conditions*

Do you have any medical condition (current or past) that could affect your ability to fully participate in an Experiential Education activity?

Yes
No

Please explain your medical condition

Are you currently taking any medication(s)?*

Yes
No

Please list your medications

Do you have any of the following conditions?

Please tick any conditions you have

Asthma
Diabetes
Recent surgery
Chronic illness
Infectious disease
Recent injury
Other

Please describe your condition

Other stuff

Everyone who comes to the festival gets a free t-shirt. Please let us know some details so you get one that fits!

Gender*

Male
Female

Size*

Transferred from

If you've received your membership/clinic spot via a transfer please add the persons name. Note - We will try to accommodate size changes with transfers but this is not guaranteed

First Name Last Name

Would you like to make a general donation to the Expedition Capital Fund?

The Expedition Capital Fund goes toward an annual expedition which is open to all festival participants from the previous year.

Acknowledgement and Consent

By checking the box at the bottom of this form, I accept and confirm that:

I am at least 18 years old
Climbing and climbing related activities are inherently dangerous and may result in serious injury or death.
The Festival is a medium for like-minded people to meet and climb together, it is not a guiding or instructional service and the Festival organisers are not responsible for my personal safety.
While Festival organisers will endeavour to ensure that any Festival events (including climbing meets) are as a safe as reasonably possible, I will exercise my own judgment about whether to participate in such events, including whether to, where to or when to climb.
The Festival organisers have not, and cannot, verify the climbing competence, skill or judgment of other Festival participants and I will exercise my own judgment about whether to climb with any other participants.
None of the Festival organisers or sponsors or volunteers will be liable for any loss or damage arising in connection with my participation in the Festival.
I understand that there are risks involved in the activities I will be undertaking. I also understand that an unpredictable or uncontrollable event may occur that could possibly cause me serious harm or death.
There are no refunds or transfers for club membership payments or festival payments.

Acknowledgement*

I acknowledge and consent to the terms of the Festival
I accept my order is non-refundable and non-transferable

Please note your registration is only confirmed when payment is received. You must complete payment in this browsing session to receive a confirmation email.

If you are registering for more than one person, please purchase and fill out this form for each person separately.

Total

$ 0.00

Transfer Course Registration

Registration

Emergency contact information

Medical history and information

Other stuff

Acknowledgement and Consent

Description