Contact & Health Declaration Form
Please complete this
form as thoroughly as possible. The
information provided on this form will be treated
as confidential and is only
required on board in order to
enable the crew to give appropriate medical help
support if required.
Trip Date Your Name
Address Date of Birth
Your Telephone Numbers
Emergency Contact Details
Contact's telephone No
Please provide a mobile number
for the morning of the trip.
Someone contactable ashore for the duration of your trip
& Dietary Details
Please tick the appropriate box if the
answer to any of the following questions is yes, and provide further
Do you have any special dietary requirements?
Do you have any allergies?
Do you now or have you ever suffered from Asthma, Diabetes, Dizziness or
Are you currently taking any medication?
Have you undergone surgery or received any medical treatment in the last
Do you suffer from any heart condition?
Do you have any other medical conditions or physical
Are you pregnant?
Please note, we do not recommend pregnant women take part in any of our
experiences, without consulting their GP.
If you are pregnant please let us know how many months..
Please initial in the box below to indicate that you have answered all
these questions to the best of your
Once you have completed this form, please select submit to send it to us,
or print and post it to the address above.
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