SECTION 1 - Personal Details:
First Name:
Surname:
Date Of Birth (ddmmyy):
Address:
Postcode:
Daytime Telephone:
Evening Telephone:
Mobile:
Email:
Occupation:
Do you have any medical conditions,
Where did you hear about
Emergency details:
Name:
Relationship to you:
Contact number whilst on clinic:
Clinic information:
Are you coming with a friend?
What is her name?
Do you wish to be in the same clinic, if this is possible? However, if your experience and aspirations are very different and the ratio is more than 1:2 it is unlikely to be possible.
Travel:
I am happy for my contact details to be sent to other Chicks attending the same clinic
I am interested in lift sharing
I am a car owner
I am leaving from…
I am leaving at…
In my car I have room for this many people
I will be arriving at about
I am happy to use my car during the course of the clinics
SECTION 2 - Costs & Dates
Now complete the relevant section:
SECTION 3 - Skills Clinic
What are you most interested in learning about? Please indicate your first, second and third choice. If you are simply wanting a fun day out in the hills with a bunch of likeminded women, please don’t be put off by these questions: we’re just trying to get an understanding of how to tune your time with us.
Have you had any instruction in any of the above?
How much summer mountain experience do you have?
Do you have any winter mountain experience?
Do you have prior experience of using an ice axe to self-arrest?
Do you have prior experience of using crampons?
Do you consider yourself to be ‘fit’ for this clinic? What exercise do you do regularly?
What do you aim to get out of the course?
Do you have any long-term goals?
Do you have any outdoor leadership qualifications?
Please go straight to section 6 next
SECTION 4 - Mountaineering Clinic
What are you most interested in learning about? Please indicate your first, second and third choice. If you are simply wanting a fun day out in the hills with a bunch of likeminded women, please don’t be put off by these questions: we’re just trying to get an understanding of how to tune your time with us.
Have you had any instruction in any of the above? Please tell us what, where, when and who it was with.
Do you have prior experience of using crampons?
Do you have any summer mountain experience?
Do you have any winter mountain experience?
Do you have any summer scrambling or mountaineering experience? Please give us details.
Do you have any summer rock climbing experience? Please give us details.
Do you have prior experience of using an ice axe to self-arrest?
Do you consider yourself to be ‘fit’ for this clinic? What exercise do you do regularly?
What do you aim to get out of the course?
Do you have any long-term goals?
Do you have any outdoor leadership qualifications?
Please go straight to section 6 next
SECTION 5 - Climbing Clinic
What are you most interested in learning about? Please indicate your first, second and third choice. If you are simply wanting a fun day out in the hills with a bunch of likeminded women, please don’t be put off by these questions: we’re just trying to get an understanding of how to tune your time with us.
What is your favourite winter climb? Why?
Do you have any summer scrambling or mountaineering experience? Please give us details.
Do you have prior experience of using an ice axe to self-arrest?
Do you have prior experience of using crampons?
Please indicate how many winter lead climbs you have done,
Please indicate how many winter climbs you have seconded (been taken up), and at what grade:
Do you have any summer rock climbing experience? Please give us details.
Please indicate how many summer lead climbs you have done:
Please indicate how many summer climbs you have seconded
Do you consider yourself to be ‘fit’ for this clinic?
What do you aim to get out of the course?
Do you have any long-term goals?
Do you have any outdoor leadership qualifications?
Do you have any winter climbing or mountaineering experience abroad?
SECTION 6 - Terms and Conditions Payment should be made by cheque or directly in to the Chicks Unleashed account. Details of this will be given on request.
I am physically fit for the course I have chosen.
I understand that the weather and climbing conditions can be severe and fickle. If your course is adversely affected by the conditions we will endeavour to provide suitable and relevant alternative training.
I appreciate that my course may be hazardous by its nature and accept a certain element of risk.
I agree to abide by such regulations as Chicks Unleashed may consider advisable.
I understand that if I wish to make an alteration to a booking I must give my new instructions in writing and an amendment fee of £35.00 will be charged
I understand if I transfer or cancel my booking within 6 weeks prior to the start of the course and if my place cannot be filled then I will be liable for the full course fee.
The remaining 50% must be paid 6 weeks prior to the start of the course.
Name:
Date:
