CHALLENGE EVENT* Select Event Girls: 27th December 20: Extreme Obstacle Course Boys: 28th December '20: Military Assault Course

Challenger First Name*

Challenger Surname *

Date of Birth (YYYY-MM-DD)*

Challenger Phone Number*

Challenger Email*

Challenger Parent/Guardian Full Name*

Challenger Parent/Guardian Mobile Number*

Challenger Parent/Guardian Email Address *

Challenger Full Address*

Challenger Postcode*

Challenger High School*

Challenger School Year*

Challenger Jumper Size * Select Jumper Size XS S M L XL XXL

Emergency Contact Name *

Emergency Contact Mobile *

GP Name *

GP Full Address *

GP Phone Nmber*

Does your child have any allergies? (If yes please specify) *

Does your child have any medical / mental health issues we should be aware of? (If yes please specify) *

Is your child currently taking any medication? (If yes please specify) *

I agree to pay a deposit of £50 (refundable upon reaching the target of £350 by 4th December 2020)
I authorise my child to take part in The Chazon Challenge.
I agree to help my child raise the target.
If required ח''ו I give permission for my child to receive first aid from trained first-aiders.
I allow for photographs to be taken of my child which may be used in publicity for Chazon.
I understand that Chazon reserves the right to remove a Challenger prior to or during the Challenge.
I have discussed these regulations with my chlid.

Waiver and Release: WAIVER COVID-19 Guidelines Due to the Coronavirus pandemic it is essential that everyone adheres to the Covid-19 safety regulations that will be imposed from the beginning of the day – including the coach journeys – until arrival back in NW London. Please see guidelines detailed below. Unfortunately, given the severity of this illness ל''ע, we will be strictly enforcing these regulations and will have to remove anyone who is not compliant from the programme. Covid-19 Safety Challengers Requirements: ● All Challengers will have had their name and contact details recorded as part of the booking process, which will be retained for a minimum of 21 days for Track & Trace purposes. ● All Challengers will be required to wear a mask when indoors and where relevant, except when eating. ● All Challengers will be provided with hand sanitiser upon arrival and departure. ● All Challengers must confirm in advance that: o They do not have a fever, continuous cough, loss of taste or smell. o They have no household contacts with symptoms. o They are asymptomatic and not required to self-isolate according to government guidance. Chazon Will Ensure: ● That the following groups of people do not attend: o Those with COVID-19 symptoms. o Those who have someone in their household with symptoms. o Those who have been advised by NHS Test and Trace to self-isolate. o Those who are in quarantine having travelled recently. o Those that have COVID-19 symptoms and awaiting test results (or their household members). ● Social distancing is strictly adhered to. ● All social interaction outside of bubbles will be actively discouraged. WAIVER This waiver relates to all activities held on the site of the Chazon Challenge • I understand the Challenge can be physically and mentally demanding • I understand the Challenge can be dangerous and the possibility of injury to myself and others exists I confirm that I am in a fit state of health and not under the influence of alcohol or drugs and I am not taking any medication that prohibits me from taking part I understand this is an extreme outdoor event with many potential hazards and that it is likely I may suffer some bruising, sprains and scrapes • I agree to participate in accordance with the stated rules I will attend training and security briefing • I will comply with the company’s rules and safety regulations and use the equipment supplied as instructed • I will obey the directions of all instructors, marshals, judges and management • I will wear all head and face protection if needed for my safety as instructed to do so and will not remove this whilst taking part/during the event(s) • I agree to return all hire equipment at the end of the event; any damage caused by myself is my responsibility, and I accept liability for the cost of repairs or replacement • I fully understand the risks involved with my participation in the event(s) and participate entirely at my own risk RELEASE I HEREBY RELEASE, REMISE AND FOREVER DISCHARGE FROM ANY CLAIMS WHATSOEVER WITHOUT LIMITATIONS THAT I MIGHT HAVE AGAINST THE COMPANY, THE OWNERS OF THE PROPERTY ON WHICH THE EVENT(S) ARE TO BE HELD AND ANY PARTICIPANT IN THE EVENT WHO MIGHT INJURE ME HOWEVER SO ARISING. I MAKE THIS RELEASE ON BEHALF OF MYSELF, ANY GROUP IN MY CHARGE, MY HEIRS, EXECUTORS, ASSIGNS AND ADMINSTRATORS EXCEPT IN THE RESPECT OF DEATH OR PERSONAL INJURY RESULTING FROM ANY OMISSION OR ACT OF NEGLIGENCE DIRECTLY OR INDIRECTLY OR THE INFECTION OF COVID19 OR ANY OTHER ILLNESS. The above does not affect your statutory rights I have read waiver and guidelines carefully, and tick boxes below to indicate full compliance I accept the above waiver and release (Parent)
I accept the above waiver and release (Challenger)