Village Health Walking Group

Indemnity and Emergency Contact Form

Indemnity (signed by each family member - parents to sign for children under 16)

First name

Last name

Phone

Other names

I/we, acknowledge that the 'Walking Group' organisers of Village Health Medical Practice, and the owners of the land used for this event accept no liability for any loss, damage or injury to ourselves (including vehicle where it is parked) resulting from our participation in this group.

I/we voluntarily accept the inherent risks associated with physical exercise and take full responsibility for any injury, loss or damage to person or property that may arise directly or indirectly from participation in the group.

I/we are aware the organisers of this group are not trained medical staff and accept I/we are essentially responsible for our own safety.

I/we will comply with safety requirements set out in the organiser's briefings.

I/we understand and agree that situations may arise during the walking group which may be beyond the control of Village Health personnel.

Emergency Contact Details (must be someone not taking part)