Disclaimer

Date:

Event Activity:

Participant Name:

Date of birth:

ADHD/ADD Diagnosis:
YesNo

On the pathway:
YesNo

Any allergies?:
YesNo

Please specify:

Funded meal?
Yes

Do you consent for photographs to be used on our social media/website:
YesNo

Name of Participant if over 18 or name of Parent/Guardian if participant under 18 years:

Email Adress:

Declaration:
I fully understand and recognise that participating in the event/activity described above may include actions or tasks that could be hazardous to me.

By clickingAccepted, digitally signing this disclaimer and clicking Submit, I accept that participating in the above event/activity can cause harm or serious injury to me. I release Calon ADHD Project CAP-CIC from all liability, costs and damages that might arise from participating in this activity save only directly caused negligence on behalf of Calon ADHD Project CAP-CIC.

Accepted:

Signed:

A copy of this Disclaimer will be sent to the email address provided.