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

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 terms and conditions: