High Sheriff of Bucks and Milton Keynes Programme

Statement of Risk

Action4Youth (A4Y) places safety as a top priority. Adventurous Activities involve some risk for the people taking part: we aim to keep these risks as low as possible. The chances of a serious injury are extremely low, but minor injuries (bruises, bumps and - less likely – minor fractures) are a possible result of taking part in Adventurous Activities. A4Y’s staff will minimise actual dangers by:

• Carrying out a careful assessment of all risks before commencing the activity
• Only using experienced instructors with the appropriate qualifications for the activity
• Giving clear safety instructions to everyone participating
• Ensuring equipment and clothing is well-maintained and suitable for the activity and the environment
• Ensuring activities are within the capabilities of the participants
• Asking participants to supply information on any medical conditions
• Ensuring good hygiene standards are kept

We expect participants to co-operate with A4Y staff, to ensure safety of all participants by following instructions and answering questions honestly about any medical conditions or other information relating to health and safety.

I understand that my son/daughter will take part at his/her own risk, and accept that no responsibility for accidents or injuries, or loss or damage to personal property rests with the supervisory staff, unless proven to be caused by their negligence. I declare that to the best of my knowledge my son/daughter is competent and medically fit to participate as part of the group. I agree that medical treatment may be sought and given if necessary in case of emergency. In the event of a medical emergency, a copy of this form may be required by medical personnel.

I understand the information from this activity may be stored digitally. I agree that a similar activity may be substituted due to safety factors or weather conditions.

I agree that in the event of my son/daughter being removed from the event due to his/her unacceptable behaviour that I will bear the costs of collecting him/her and returning him/her to home.

I have read and understand the statement of risk assessment associated with walking and camping unaccompanied in wild country areas but with remote supervision by trained staff.

Participants/parents are responsible for the condition and suitability of their own equipment. If any kit fails or proves to be inadequate during an expedition you will be responsible for any cost incurred should it need to be rectified.

Application is not valid without acceptance.

Data Protection

The information you supply will be used by Action4Youth for administrative purposes within the terms of the Data Protection Act 1998. We shall not supply it to third parties.