Lister Abseil

Saturday, 29 March 2025, 09:00 - 17:00

Lister Hospital, Coreys Mill Lane, Stevenage, SG1 4AB View Map

My Details

First Name *

Last Name *

Date Of Birth *

Gender *

Male Female *

Charity T-Shirt Size *

Contact Details

Email *

Phone Number *

Emergency Contact Name *

Emergency Contact Number *

My Address

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Address Line Two

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County

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Staff Details

NHS Email *

Department *

Job Title *

I pledge to raise �200 minimum sponsorship

I have read and understand the Terms & Conditions *

I recognise and acknowledge that there are certain risks to participants and I voluntarily and knowingly agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that I may sustain of said participation. I further agree to waive and relinquish all claims I may have (or which may accrue to me) as a result of participating in these activities against the East and North Hertfordshire Hospitals� Charity (part of the East and North Hertfordshire NHS Trust, including its employees, the agents, volunteers, sponsors, and the owners of the 
land. I agree that I am solely responsible for determining if I am physically fit and/or skilled for the activities contemplated by this assumption and release. It is always advisable, especially if the 
participant is pregnant or disabled in a way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity. I, for myself and my heirs, do hereby fully release and forever discharge the administrators from any and all claims for injuries, including death or incapacity, illnesses, damages, expenses or loss that I may suffer arising out of, connected with, or in any way associated with the event, or associated with transportation to and from the event. I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. By completing this disclaimer I have agreed to pay the booking fee of �40 or �20 if I am an NHS staff member and to donate 
or raise a minimum of �200 in sponsorship for the East and North Hertfordshire Hospitals Charity. If your minimum sponsorship target of �200 hasn�t been reached 3 months after the event, I agree to pay the 
remaining balance to the charity. When your booking form has been received the charity will make contact to send event information which includes information and advice on fundraising. By taking part in the event, I agree to receive these communications. The charity will not contact you in the future about support unless consent has been given.

Dolomite Training Terms & Conditions 
Acknowledgement of Risk
I understand that outdoor adventurous activities may be physically, mentally and emotionally challenging. I accept that there are inherent risks associated with this type of activity. 
I understand the following: 
� The environment that the activities take place is a wild one which has natural hazards and risks.
� I accept that I need to take responsibility for myself and others whilst on any activity with Dolomite Training. 
� I must at all times follow the safety instructions and ensure that all safety equipment is being used correctly. 
� If I do not adhere to the instructions given by Dolomite staff there is a risk of injury that could be fatal. 
� If I do not understand the instructions or I become confused about the instructions I will ask for help from Dolomite staff. 
� Dolomite staff reserves the right to stop an activity with no refund if they deem you to be unsafe or unfit to participate.
� I must inform Dolomite staff of any health or medical issues that may affect my ability to participate in these activities safely. 

Consent for Emergency Care / Pictures 
1. I give permission for Dolomite Training staff to sanction emergency medical care during any activity conducted by Dolomite Training. 
2. I give Dolomite Training permission to take pictures and use them for promoting their activities only. They are not to be used for any other purpose.

I have read and understand the Terms & Conditions *

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Lister Abseil

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