DD slash MM slash YYYY
Are you, to the best of your knowledge, fit to complete the activity
Do you suffer from epilepsy, seizures, diabetes, abnormal blood pressure, heart disease, angina, asthma or similar ailment?
Do you suffer from deafness, visual impairment or any other disability that may affect your learning?
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.