Please complete the online medical form and submit prior to the activity.

 
Participant Name *
Participant Name
Date of paddleboarding activity *
Date of paddleboarding activity
Please complete month, day and year
Date of Birth *
Date of Birth
Please complete month, day and year
Previous relevant experience *
How would you describe your fitness level?
Are you able to swim? *
Has your doctor ever said you have heart trouble? *
Have you ever had pains in your chest? *
Do you often feel faint or have spells of dizziness? *
Has a doctor said your blood pressure is too high? *
Have you been in hospital in the last 3 years? *
Do you suffer from asthma or have any other breathing difficulties? *
Do you suffer from diabetes, epilepsy or a mental disorder? *
Do you suffer from an allergy? *
Bone or joint problems, that has been aggravated by exercise? *
Are you pre/post natal? *
Are you on any medication? If so what is it and why? *
Awareness of Risk and Informed Consent *
If under eighteen this form must be read and signed by a parent or guardian of the participating young person on their behalf. It is the responsibility of the parent/guardian to ensure that the young person is aware of the risks involved in participating in adventurous activities, and that they understand the importance of the following terms. In consideration of being allowed to participate in the activities of Psyched Adventures ltd (trading as Psyched Paddleboarding) and to use the facilities and equipment owned and/or under the control of Psyched Paddleboarding, in addition to the payment of any fee or charge, I understand and I am aware that paddle sports and outdoors activities are potentially hazardous activities. I also understand that paddle sports and outdoors activities can involve a risk of injury and even death, and that I am voluntarily participating in these activities and using equipment and facilities with the knowledge of the dangers involved. I hereby agree to expressly assume and accept all and any risks of injury or death. I am aware that I have the right to request advice from any of the Psyched Paddleboarding instructors, at any time, in relation to the activities being undertaken and, but not exclusively, their suitability for me, with particular regard to my health and clothing. If I choose not to take advice, or to disregard any advice so given, I do so voluntarily and accept liability for all resulting injuries or damage. I do hereby declare myself to be physically sound and suffering from no condition, impairment, disease or infirmity or other illness (other than those declared on the attached Booking Form) that would prevent my participation or use of equipment or facilities except as herein stated. I acknowledge that I have either had a physical examination and have been given my doctor’s permission to participate, or that I have decided to participate in activity and use of equipment without the approval of my doctor and do hereby assume all responsibility for my participation and activities, and utilisation of equipment in my activities. In addition Psyched Paddleboarding, cannot accept responsibility for valuables l leave whilst out paddleboarding. I consent to my personal contact details (name and phone number/s) to be circulated to the appropriate Psyched Paddleboarding instructor team. I also consent to the contact details of my Emergency Contact (name and phone number/s) to be used by the appropriate Psyched Paddleboarding instructor team team and Psyched Paddleboarding Director if necessary. I will ensure that I am fully prepared for my activity day, bringing appropriate clothing and footwear for the activities I am participating in and the weather conditions, plus a full change of clothes and any medication I may need. Whilst under Psyched Paddleboarding’s instruction, I will listen carefully to and abide by all oral instructions and rules given to me by Psyched Paddleboarding Staff Members. I understand that failure to do so may result in an accident. I agree to wear all safety equipment provided by Psyched Paddleboarding in the manner demonstrated by Psyched Paddleboarding Staff. I understand that certain elements of participation in outdoor activities will involve physically challenging activities. I acknowledge that I am responsible for my own behaviour whilst under Psyched Paddleboarding’s instruction. Offensive, aggressive or disruptive behaviour will result in the participant leaving the session, or premises. I acknowledge that I am also responsible for my own possessions whilst under Psyched Paddleboarding instruction. We advise that valuable possessions are left at home. By signing the form, you consent to Psyched Paddleboarding using any media (including photographs and/or video footage) made of you during the event which may or may not encompass intellectual property rights belonging to you and that these images may be used by Psyched Paddleboarding for publicity and training purposes including, but not limited to: in brochures, social media, websites, marketing material and in the press. If you do not wish for your image to be used you must inform Psyched Paddleboarding, in writing, at the time of agreeing to these terms. I have carefully read and understood the risk and consent form and I agree to these terms.