Medical Declaration

Name *

First

Last

Name of person who booked this event if different from above

Address *

Phone Number *

Email *

Date of Birth *

DD/MM/YYYY

Which event will you be taking part in? *

Date of the event you will be taking part in. *

Do you have any medical conditions or allergies which we should be aware of, which may affect your ability to participate, or which may require sudden treatment during the event? *

If you answered yes to the previous question, please provide details.

We need to be aware of any medication that you will be bringing on the day and how to administer such medicines in case of emergency eg. Insulin.

Any other medical conditions we should be aware of? *

Please enter N/A if there are no further medical conditions.

Do you have any dietary requirements?

If Elite Adventures is providing food for your event please let us know of any dietary requirements so we can ensure your needs are met. If we are not providing food for your event please skip this question.

Emergency contact name *

First

Last

You should not choose another participant as your emergency contact.

Emergency contact phone number *

Your relationship to the emergency contact *

I consider myself to be fit and in good health, there is no medical reason why I should not participate in activities offered by Elite Adventures. In the event of an accident during my activity, I give full permission for the relevant instructors, who are suitably trained in First Aid, to administer whatever First Aid treatment they deem appropriate under the circumstances (except as listed above). *

I agree

I declare i have read, understood and answered truthfully all of the questions listed in this medical document. Please write your name in the box below. *

Waiver

This form is important and should be read carefully and your attention is particularly drawn to paragraph 3.

You must sign and return this form to Elite Adventures (the “Organiser”) on event days at registration prior to participating in any activities

1. I HAVE HAD IT EXPLAINED TO ME AND UNDERSTAND THAT:

1.1 the activities undertaken on this event are physically and mentally challenging and potentially dangerous, and include but are not limited to natural obstacles, surface hazards and weather conditions;

1.2 there is a risk of serious injury and/or death associated with my participation in activities with Elite Adventures;

1.3 although adherence to strict safety standards and health & safety assessments minimises these risks, they cannot be completely eliminated; and

1.4 participation in activities on an Elite Adventures event is ENTIRELY AT MY OWN RISK.

2. I CONFIRM THAT:

2.1 I am 18 years of age or older.

2.2 I am fully aware of the risks to myself and others associated with participation in activities on an Elite Adventures event. These risks include damage to or loss of personal property, personal injury and in extreme cases, death.

2.3 I will comply with all instructions given to me by the Organiser’s officers and employees, and use any equipment as directed and not so as to hurt or injure others.

2.4 I am sufficiently fit and healthy to safely participate in this event and do not suffer from any medical condition which would adversely affect my ability to safely participate in all activities at this event.

3. RELEASE

3.1 I hereby acknowledge and accept that the Organiser and Elite Adventures Staff shall not be liable to me for any loss or damage arising from my participation in the activities on this event, including indirect or consequential loss or damage.

3.2 Nothing in this disclaimer shall be construed as limiting or excluding the Organiser’s liability for:

(a) death or personal injury which arises as a consequence of the Organiser’s negligence, or the negligence of the Elite Adventures Staff; or

(b) fraudulent misrepresentation; or

(c) any other matter for which it would be illegal or unlawful for the Organiser to exclude or attempt to exclude its liability.

4. AGREEMENT

4.1 I have read and fully understood all the terms of this disclaimer. I confirm that I am not relying on any statements or representations by any person or entity as an inducement to my fully and voluntarily engaging in the activities with Elite Adventures and assuming the risks and obligations stated above in signing this document.

4.2 I acknowledge that the nature of my participation in Elite Adventures activities is potentially hazardous and that if I am unwilling to accept the risks associated with my participation, I should not take part.

4.3 I give permission to the Organiser to use my photograph and/or any other record of my participation on this event for any legitimate purpose. I understand that any and all likenesses of me captured during the event by the Organiser or Elite Adventures Staff shall become the sole property of the Organiser.

4.4 If any court or competent authority finds that any provision of this document (or part of any provision) is invalid, illegal or unenforceable, that provision or part-provision shall, to the extent required, be deemed to be deleted, and the validity and enforceability of the other provisions of this agreement shall not be affected.

PARTICIPANTS MUST BE OVER 18 YEARS OLD TO SIGN AND TAKE PART IN THIS EVENT.