• Medical Form

  • Date Format: DD slash MM slash YYYY
  • Date Format: DD slash MM slash YYYY
  • Health

  • Are you, to the best of your knowledge, fit to complete the activity
  • Do you suffer from epilepsy, disability, giddy spells, diabetes, deafness, heart disease, angina, asthma or similar ailment?
  • Next of Kin

    Please make sure it's someone that's not on the activity with you.
  • I declare that the responses I have given above are correct to the best of my knowledge and I know of no reason related to my health and well-being that will prevent me from undertaking this activity. I will inform the skipper/instructor immediately if I have any difficulties during the activity.
  • This field is for validation purposes and should be left unchanged.