Medical Information

Page 2 / 3

All persons taking part in activities must complete the following fields as fully as possible prior to activity commencement. All information given will be treated with the strictest confidence.


1. General Medical Details

Do you have any medical conditions?


Are you receiving any medication or treatment?


Do you suffer from allergies? i.e. stings, bites, penicillin, elastoplasts etc


Are you prone to repetitive sports injuries?


Can you swim? (if no please state if water confident)


Do you have any dietary needs?
i.e. vegetarian, celiac etc (only applicable if ordered packed lunches)


Are there any areas we have not yet covered that you feel may be relevant?


For equipment purposes i.e. wetsuits, buoyancy aids please provide your approx. Height, Weight, Chest Size.


Emergency Contact Details

please provide Surgery Name, Town, Postcode

If the above details are correct, please proceed to the final page - Disclaimer.