Eastern Mamores Booking Form Name * First Name Last Name Date of birth * MM DD YYYY Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Choose Date 19th June 10th July 31st July 21st August How many people would you like to book for? 1 2 3 4 Any medical conditions or recent injuries? Please outline for all of your group. (e.g. Asthma, heart condition, sprained ankle). * Name and phone number of emergency contact * If you have any hillwalking or relevant experience, please let us know here I understand that it is my responsibility to obtain personal accident and event cancellation insurance if I wish to do so. I also accept that there is an element of risk associated with this activity and am aware of the potential dangers. Yes No It is okay for Caledon Coaching and Guiding to take photos of myself on the walk for use on social media. Yes No I accept that if the conditions are not suitable for myself or the group (snow, ice, strong winds) then the event may be altered and a walk in the area that does not put myself or members of the group in danger will be walked instead. I also accept that if Caledon Coaching and Guiding cancel the event, I will receive a full refund. I accept that if I cancel my booking before 4 weeks of the start date of the event, I will receive a full refund. I accept that if I cancel my booking less than 4 weeks before the start date of the event, I will not receive a refund. Yes No Thank you!
