Event registration
Welcome to registration for the Diabetes UK High Rope Activity Course event at Wild Pines for 11-15yrs. Please fill in the following form to register for the event.
1. First Name
*
2. Last Name
*
3. Email Address
*
4. Phone number
*
5. Address line 1
*
6. Address line 2
7. City
*
8. County
9. Postcode
*
10. Are you a
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Person living with diabetes over the age of 16 who would like to attend the event themselves
Parent or carer of a young person living with diabetes who you'd like to attend event
11. Please tick this box to confirm that you understand the risks associated with activities provided by Wild Pines and that Diabetes UK are not liable for any potential accident, injury or death.
*
Yes I understand
12. Please tick this box to confirm that you understand that the diabetes management of each child is the responsibility of their own parent/carer who must remain on site at all times.
*
Yes I understand
