• Outdoor Medical Form

    It is important that we know about special requirements for participants in our events. Anyone attending a Rockburn Ltd outdoor course (participating or spectating) should complete this form and 'Submit' before you arrive. Alternatively, this can be printed from the Outdoor Events page on our website at http://rockburn-bridport.com/outdoor/ and brought with you to the event.
  • Event Date*
     - -

  • Participant Information:

    Please provide information of medical conditions/illnesses/ allergic reactions that participants have (e.g. food allergy, heart conditions, pregnancy, back problems) and any medication that is used to control these conditions (e.g. inhaler, Adrenalin etc.):

    If there is an existing medical condition, we recommend advice is sought from a GP to establish the suitability of the activity.

  • Rows

  • Emergency Contact Information:

  •  -

  • Declaration:

  • I confirm that:*
  • Date of Completion*
     - -
  •  
  • Should be Empty: