Reservation form for activities at Ballyhass Activity Centre, Mallow, Munster

Climbing at Ballyhass Lakes Activity Centre

Archery at Ballyhass Lakes Activity Centre, Mallow

Cecilstown, Mallow, Co. Cork, Ireland

Tel:+353 (0)22 27773 Fax:+353 (0)22 27990 Email: info@ballyhasslakes.ie W 8.79858 N 52.17395

Reservation & Consent Form

Call us on +353 (0)22 27773 to discuss your group reservation or use the form below to submit your request.

Please enter your details below to submit your reservation & consent electronically, alternatively you can download a printable version of our reservation & consent form by clicking here. You will need Adobe Reader to view this form.

Participants Name:

Address:

Email:

Date of Birth:

Gender:

male female

Tel No:

Parent/Guardian mobile:

Course Dates required:

from:

to:

Consent & Declaration:

I, (Parent/Guardian) confirm that I have the authority to consent that the above mentioned participant may be conveyed by ambulance, car or other means to hospital or a doctor for the purpose of medical attention where is deemed necessary by Ballyhass Lakes staff.
Does your child have any medical condition or allergy? yes no

If yes please specify:

Does your child take any medicine? yes no

If yes please specify:

I agree to the :