Medical & Consent - SURVIVAL & OUTDOOR SKILLS CEBU

Course attended *

Name *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Country *

Date of course/class *

1. The course can be physically and mentally demanding and may require excessive exertion.

2. The possibility of personal injury to me and others exists

3. The course may expose me to hazards (Burns, Cuts, feeling cold or hot)

4. I am fully aware of the risks to myself and others whilst attending an S.O.S.C. course and agree to abide by the rules at all times.

5. I am physically fit and mentally able to partake in the Outdoor course. If I feel to unwell to continue I shall alert a member of staff immediately.

6. I agree to comply with the rules as given to me by S.O.S.C. staff, to use all equipment as instructed and obey all directions given by S.O.S.C. staff.

Do you have a history of any other illness or learning difficulty not mentioned above . If so,please state illness below:

Are you under any medication at the moment ? If so please give details below.

Dietary requirements *

VegetarianVeganFood allergiesNone

If you have ticked the Food Allergies box please explain below.

EMERGENCY CONTACT DETAILS

Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Country

Phone *

Relationship *

Medical and Consent

Medical Questions *

Dietary requirements *