22ND APRIL Contact or visit cancerresearchwales.co.uk/abseil to download your information pack

Transcription

1 l i e s b A CARDIFF CITY STADIUM 22ND APRIL 2017 Contact or visit cancerresearchwales.co.uk/abseil to download your information pack Cancer Research Wales, Velindre Cancer Centre, Whitchurch, Cardiff, CF14 2TL. Registered Charitable Incorporated Organisation Number:

2 Abseil Event Information Pack Date: 22nd April 2017 Time: The first abseil will begin at 10am, your exact abseiling time will be issued at a later date Location: Cardiff City Football Club Stadium, Leckwith Road, Cardiff, CF11 8AZ In association with ITINERARY: *NB: Your exact itinerary for the event will be issued at a later date once your place is confirmed. Upon arrival at Cardiff City Stadium you will be greeted by Cancer Research Wales staff who will direct you to the appropriate area of the stadium. Once you have been registered by CRW staff there will be a chance to have a hot drink before heading to the room where JT Expeditions instructors will be waiting to brief you, and your abseiling equipment will be fitted. Once your harness and helmet have been fitted you ll make your way to the rooftop where another instructor will be waiting to give you an abseiling brief before lowering you from the rooftop of the stadium down the 60 foot abseil!

3 Abseil Event Information Pack EQUIPMENT LIST: Warm fleece or jacket Waterproof Jacket Appropriate trousers/shorts: ensure that they are comfy and not restricting with nothing dangling from them. Skirts are not appropriate for abseiling. Trainers or walking shoes - absolutely no sandals, heels or daps. Running/gym trainers are best. Water and snacks Hairbands for tying longer hair back *NB: Please do not wear dangly jewellery around your neck, ears, hair or excessive jewellery on your hands. You will be asked to remove any clothing or jewellery that is deemed a safety risk by an instructor. Please also ensure that you bring a selection of hair bands to tie longer hair back. Long hair that is not secured is a safety risk when abseiling. All personal protection equipment (harness, helmet, ropes etc) and safety & emergency equipment will be provided by JT Expeditions.

4 Abseil Event Information Pack EQUIPMENT LIST: Food and Water Please ensure that you are well hydrated before and during your day, and that you eat a sufficient meal before abseiling. Hot drinks will be provided on the day. There are local shops where you can purchase food and snacks. Abseil Safety Safety is critical within the abseiling environment, you will be accompanied by a qualified and insured Single Pitch Award holder (rock climbing instructor) with vast experience in climbing and mountaineering instruction. Your instructor holds a valid outdoor specific First Aid Certificate and will carry appropriate safety equipment at all times. We require that you pay attention and adhere to their instructions and guidance at all times to insure your own safety and do not act in a manner that could potentially risk the safety of the instructor, the group or yourself. Further information is provided in the Event Participant Contract

5 Abseil Event Information Pack FINANCIAL INFORMATION: A registration fee of 50 to Abseil this Welsh football stadium is applicable to secure your place. We ask all participants to raise a minimum sponsorship of 199 to support Cancer Research Wales in this event. Please LIKE Cancer Research Wales & JT Expeditions on FACEBOOK, and FOLLOW us on TWITTER and INSTAGRAM: Registered Charitable Incorporated Organisation Number:

6 Abseil Event reservation form Please complete this form (in BLOCK CAPITALS and black ink) along with the Participant contract and Medical Form and return it to the address below as soon as possible. Please also provide your 50 booking deposit cheque (payable to Cancer Research Wales ) or credit card details (see below). On Saturday 22nd April 2017at Cardiff City Stadium, a special Abseil event is taking place on behalf of Cancer Research Wales. Please return this form to the address below by 17th April 2017 if you would like to take part. How did you find out about the Abseil? E.g. promotional stall, social media, company or charity newsletter? Full Name: Full Address: Postcode: Contact Telephone Number: Mobile Number: Address: Male Female Height: Weight: I enclose a cheque payable to Cancer Research Wales Please charge my Visa / Mastercard / Delta / Switch with the following amount Valid From Expiry Date 3 digit code Card Number (back of card) Issue No (switch only) / / IMPORTANT: I confirm that I am 15 years or older and I have read the Event Participant Contract. Including- Terms and Conditions, Medical Restrictions, Insurance and Important Notice overleaf (if these are not listed then please call to request a copy) and I understand and agree to be bound to those terms and conditions and to comply fully with the same. Signature Date Tick here if you do not wish to receive details of other offers from the charity Please send this form and your deposit to: Cancer Research Wales, Velindre Cancer Centre, Cardiff, CF14 2TL Registered Charitable Incorporated Organisation Number:

7 Event Participant Contract Cardiff City FC Abseil : You must be at least 15 years old before the date of the event, those under 18 require signed permission/consent from their parent or legal guardian 1.2: Body size can be a limiting factor to your suitability for the abseil event. If you are unable to fit in our harnesses then you unfortunately cannot abseil. If you have any concerns that you may not fit in our harness and thus be suitable for the event please get in touch with JT Expeditions on It is difficult to give a maximum weight as this is not always an indication of body size and shape. There is no minimum weight to take part. 1.3: You participate at your own risk. You must complete the medical questionnaire that will be sent to you and keep JT Expeditions advised of any medical conditions that develop prior to departure that could endanger you during the event. In some circumstances, a doctor s certificate/signature may be required. 1.4: Public Liability Insurance - JT Expeditions has its own insurance with the Activities Industry Mutual (AIM) for 5,000,000 for providing Overseas Expeditions and UK activities. JT Expeditions also hold Employers Liability Insurance with AIM for 10,000,000. Copies of these certificates are available upon request. 1.5: Instructors/Guides - All guides are Single Pitch Award qualified with an appropriate 16 Hour First Aid Certificate as a minimum. 1.6: Personal Medical / Cancellation Insurance - JT Expeditions would advise that you take out your own insurance to cover you in the case of injury during any activity break. It is your responsibility to purchase an appropriate insurance policy. 1.7: If you sustain an injury before the event, please contact JT Expeditions in writing at the earliest opportunity. 1.8: Personal protection equipment, ropes and all other absolving equipment will be provided but you must provide your own personal clothing/equipment as per the appropriate information pack issued to you. 1.9: All participants agree that images taken on the challenge may be used by JT Expeditions in future promotional material, unless stated otherwise. 2.0: Entry and on going participation in the event is at JT Expeditions discretion and it reserves the right to refuse entry to any participant or withdraw them from the event at any time if it considers that such participation is inappropriate : If your removal from the event by JT Expeditions is due to unsuitable or inappropriate behaviour, then it is your responsibility to make any required arrangements afterwards

8 : If your withdrawal/removal by JT Expeditions is due to medical or physical reasons then the JT Expeditions staff will do our best to treat and cater for you. In some case you may be taken to the nearest medical facility or appropriate medical help may be sort after You certify that, to the best of your knowledge, all information you have provided on the Medical Questionnaire is correct and will be correct on any further forms you will be sent in respect of this event. I certify that I have read, understand and agree to JT Expeditions terms and conditions in this contract. I also understand that failure to comply with these terms and conditions could result in immediate exclusion from the event. Signature Print Date

9 Medical Questionnaire Please complete the forms below with as much accuracy as is possible, it is for your personal safety and is your responsibility to inform us of any issues relating to your health and fitness. Please update JT Expeditions with any changes to your medical and personal information after filling out this form. Any medical conditions do not necessarily affect your suitability for a abseil challenge with JT Expeditions. Personal details Title: Surname: First Name: Address: Contact Numbers: address: Date of Birth (dd/mm/yy): Occupation: Next of kin Next of kin must be a relative or friend who is not present during the challenge. It is essential that our information is kept up to date prior to and during the challenge therefore please inform us immediately of any changes to your information. Relationship to you: Name: Address Postcode Daytime/mobile numer: Evening/landline number: address: Your GP Name of your GP: jakethompsett@jtexpeditions.co.uk +44 (0) (0)

10 Doctor s surgery address & postcode: GP s contact telephone number: Emergency contact telephone number: 1. Do you, or have you ever suffered from (please tick appropriate): Vertigo Yes No Heart trouble and/or blood pressure problems Yes No Asthma, bronchitis and/or shortness of breath Yes No Diabetes Yes No Epilepsy and/or fainting attacks Yes No Migraine Yes No Severe head injury Yes No Back problems Yes No Allergies Yes No Fractures, tendon, ligament/cartilage damage Yes No Physical or other disability Yes No Psychiatric or mental illness Yes No Sickle cell anaemia / sickle cell trait or another inherited blood disease * Yes No Any other ailment, complaint or medical condition which might affect your ability to take part in the planned activity Yes No Have you / do you / are you (please tick appropriate): Attended hospital/doctors for any investigations, treatment or medication in the last two years Yes No Have any forthcoming medical appointments (other than routine check-ups) Yes No Suffering from or a carrier of any infectious diseases Yes No Smoke Yes No How many per day on average? How much alcohol do you consume on average per week? (units) jakethompsett@jtexpeditions.co.uk +44 (0) (0)

11 A history of any medical problems in your family Yes No Suffer from any other conditions that are not stated above Yes No Currently use any form of medication Yes No When was the date of your last Tetanus injection? If you have answered yes to any of the above questions, please give further details below (use a separate sheet if required). Please include details of any medication taken Doctors Signature If you have a significant pre-existing medical condition or you have received hospital treatment within 2 years of the abseil which JT Expeditions have expressed concern for, you must ask your doctor to sign below confirming that you are fit to undertake the challenge. I confirm that I have read the itinerary my patient is planning to undertake and declare them medically fit and able to take part. Signature: Date: Print Name: GMC Number: jakethompsett@jtexpeditions.co.uk +44 (0) (0)

12 Participant Declaration and Consent I. confirm that the information I have given above provide a true and complete representation (to the best of my knowledge) of my medical history and current conditions. I declare that I am physically and mentally capable of participating safely. I understand that abseiling and the associated recreational activities have risks that are possibly very dangerous. I understand that although JT Expeditions will teach me how to manage these risks and will imply appropriate procedures and risk assessments to help minimise and manage them, JT Expeditions can never remove them. I confirm that I accept responsibility for my own actions and involvement when participating in this challenge, and confirm that I will not act in an inappropriate way that can lead to harm of any other challenge members or myself. I also confirm that I have read and accepted the terms of the Event in the Participant Event Contract. I authorise JT Expeditions or appropriate first aid or medically qualified staff to give medical treatment during the challenge in an emergency and to contact my Next of Kin in the event of my hospitalisation. Signature Print Date jakethompsett@jtexpeditions.co.uk +44 (0) (0)

13 WILL BE TAKING PART IN The person named above has agreed to take part in the sponsored event in aid of Cancer Research Wales. They would like to raise as much money as possible through sponsorship, to help us fund our world leading research into the early diagnosis, preventatives and better treatment of cancer. Thank you for your support. SIGNATURE DATE ADDRESS POSTCODE HELP CANCER RESEARCH WALES TO CLAIM AN ADDITIONAL 25% ON YOUR DONATION AT NO ADDITIONAL COST TO YOU I am a UK taxpayer and would like Cancer Research Wales to reclaim tax on the donation detailed below, given on the date shown. I have included my name and home address below and have ticked the Gift Aid Box. (I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.) FULL NAME ADDRESS Please don t use your work address POSTCODE AMOUNT PLEDGED ( ) AMOUNT GIVEN ( ) DATE GIVEN GIFT AID Please tick PLEASE SEND COMPLETED SPONSOR FORM AND FUNDS TO: Cancer Research Wales, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL Tel: Registered Charitable Incorporated Organisation Number TOTAL DONATIONS To be completed by Cancer Research wales DATE SUMS RECEIVED TOTAL INCOME TAX TO BE RECLAIMED ON DONATION

14 FULL NAME ADDRESS Please don t use your work address POSTCODE AMOUNT PLEDGED ( ) AMOUNT GIVEN ( ) DATE GIVEN GIFT AID Please tick MAKE A JUSTGIVING FUNDRAISING PAGE ONLINE! IT S THE FASTEST, EASIEST, AND CLEVEREST WAY TO RAISE MONEY! Make a page and share it online with your family and friends. Anyone can donate with a credit/debit card from anywhere in the world. Justgiving sends your donations straight to us and reclaims Gift Aid automatically on our behalf. Cancer Research Wales, Velindre Hospital, Cardiff, CF14 2TL Registered Charitable Incorporated Organisation Number