Make a Booking Please read our Terms and Conditions carefully before completing the Booking Form, as you need to agree to them in order to process the form. If you would prefer, you can also download the booking form to print, complete and send to us by post. Event Details * denotes required field Event Name*: Event Date*: About You Male Female Full Name*: Home Address*: Email Address*: Subscribe to our Newsletter: Yes No Landline Number*: Mobile Number*: Date of Birth*: eDofE Number (for Duke of Edinburgh Award bookings only): Award Levels Achieved (for DofE bookings only): Location of previous Practice/Qualifying expeditions (for DofE bookings only): Fitness / Experience Please tell us of any of your relevant experience: How would you describe your fitness level: Poor Unfit Average Very Fit Dietary Requirements Please list any special dietary requirements: Please answer the following questions 1. Has your doctor ever said you have heart trouble? Yes No 2. Have you ever had pains in your chest? Yes No 3. Do you often feel faint or have spells of dizziness? Yes No 4. Has a doctor said your blood pressure is too high? Yes No 5. Has a doctor said that you might have bone or joint problems, such as arthritis, that has been aggravated by exercise or might be made worse with exercise? Yes No 6. Have you been in hospital in the last 3 years? Yes No 7. Are you currently taking any medication? (see Q12.) Yes No 8. Are you Pre/Post natal? Yes No 9. Have you been diagnosed with asthma or have any other conditions that affect your breathing? Yes No 10. Have you been diagnosed with diabetes, epilepsy or a mental health condition? Yes No 11. Are you allergic to anything? Yes No 12. If you answered ‘Yes’ to Q7, what medication do you take and reasons why? 13. If you answered ‘Yes’ to one or more questions, please provide details and dates: Emergency Contact This should be someone we can contact in the event of an emergency, not someone on the activity with you. Emergency Contact Full Name*: Emergency Contact Landline Number*: Emergency Contact Mobile Number*: Are you 18 or older? Yes No If you are 18 or older, please skip to the final section. If you are under 18, please ask your parent / guardian to complete the next section and submit on your behalf. Parent / Guardian If participant is under 18, the parent / guardian must accept on the participants behalf and provide details in the boxes provided. Parent / Guardian Full Name: Parent / Guardian Landline Number: Parent / Guardian Mobile Number: If you are the Parent / Guardian, please make sure you have read our Terms and Conditions and then submit the booking form. Snowdonia Giving / Rhodd Eryri Yes, I would like to donate a further £1 in addition to my event cost to support Snowdonia Giving and help look after and develop Snowdon and its surrounding areas.(By ticking this box, we will add £1 to your booking cost and this will be shown on your invoice/receipt) Acceptance of Terms and Conditions Yes, I have read, acknowledge and accept the Terms and Conditions and Informed Consent / Liability Waiver.