Norfolk Paddle Boards Medical History Form
This legal form must be filled out by all who are attending a lesson or Social Sup Session. To complete this form you must be over the age of 18 or over, Parent or a Guardian whom has authority to do so. There must be a separate form filled out per member in your group.
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Name *
Date Of Birth
MM
/
DD
/
YYYY
Email
Contact Telephone Number
Emergency Contact Telephone Number *
Can you swim 50m unaided? *
We aim for you not to fall in so if you can't swim, its ok. Its just so we know peoples abilities.
Required
Do you currently suffer or had any of these conditions in the past? *
Please SELECT THE BOX'S BELOW TO CONFIRM IF YOU HAVE OR HAD ANY OF THE BELOW CONDITIONS
Required
If you selected any of the boxes above please can you give further details below?
If you have said yes for any of the above please confirm you have sort medical advise and they are happy for you to take part in the session.
Photographs & Video - Can we use your picture? We occasionally take photos & video of lessons for our social media & marketing. *
Do you wish to be contacted by us regarding occasional relevant promotions, surf trips, lessons etc *
Data Collection * I give permission for Norfolk Paddle Boards to store and use my medical information if required. *
I am required to complete this annually or to update Norfolk Paddle Boards with any changes.
Please Sign - Medical Declaration * I hereby confirm that the information i have provided above is accurate and i understand that Norfolk Paddle Boards will not be held liable for any incident or injury caused by an existing health condition not stated. *
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