Medical Consent Form

THERAPEUTIC BUSH ADVENTURE PROGRAMS

The medical informaVon that you provide will help us to understand you and your needs, so we can give you the best possible experience, and provide you with the right support to keep you and others safe. Able 2 Bush Adventure Therapy programs create the opportunity to spend time in the bush connecting with nature and engaging in outdoor activities which encourage exploration of yourself and others. Experienced outdoor recreation professionals tailor a series of adventure-based activities to suit the individual needs of participants. Over the course of the program, through shared experiences and overcoming challenges, participants will gain a range of outcomes which support them in their lives.

Personal Details

Name

Date of birth

Age

Home Address

Suburb

Postcode

Phone

Medicare Number

Number on card

Ambulance cover

Emergency Contact

Name

Relationship to the participant*

Emergency Contact Phone

Emergency Contact Email

Participant Ageement

I agree to the below terms

I agree to participate in, or agree to my son/daughter/ward participating in the activities which are a part of Able2’s Bush Adventure Therapy program. I understand that the activities which may be engaged in could include bushwalking, camping, mountain biking, canoeing, kayaking, basic bush skills and swimming.
I agree and understand that Bush Adventure Therapy sessions are conducted with a solo practitioner and participant. Dependent on client needs, these sessions may occur in isolated bush locations.

I agree and understand that Able2 staff will take reasonable care for the welfare and safety of those attending the program, but are not responsible for any accident or sickness otherwise occurring. I acknowledge that although the activities will be fully supervised by qualified staff, that there are risks which are inherent in or incidental to the activities.

I acknowledge the risk of physical or mental injury (including the aggravation, acceleration or recurrence of such and injury), to myself (or the participant) arising from my (or his/her/their) participation in the activities and I (or the participant) accept that this risk is my (or his / her / their) own risk.

I agree that, to the extent permitted by law, Able2 Pty Ltd and its servants and agents shall not be liable pursuant to tort (including negligence), statute and/or contract for any physical or mental injury (including the aggravation, acceleration or recurrence of such an injury) to myself (or the participant) arising from or in relation to my (or the participant’s) participation in the activities.

I have detailed herein and on any attached pages any disabilities or susceptibilities affecting myself, (child / ward), that may place me (him/her/them), at greater than normal risk. I authorise Able2 and its staff to obtain medical assistance and ambulance transportation in the event of illness of injury as they think necessary and authorise qualified medical practitioners to administer any procedures deemed necessary.