Please enable JavaScript in your browser to complete this form.Participant's Name *FirstLastAddress *Mobile Number *Email *Gender *MaleFemaleDate of Birth *Doctor's Name, Practice & Phone Number *Emergency Contact #1 *FirstLastMobile Number #1 *Emergency Contact #2 *FirstLastMobile Number #2 *Tick any of the following that apply to you *DiabetesCold/Flu/COVID-19Heart TroubleEpilepsyHigh Blood PressureCirculation ProblemsOsteoporosis/ArthritisBowel/Bladder ProblemsAIDS/HIV PositiveSmoke CigarettesCancerDizziness/Blackouts SometimesSudden Weight LossBreathing ProblemsPregnantRecent SurgeryAllergiesNo Health ProblemsPlease supply further info about your selections aboveAny other health conditions we should know about? *List all medications you are taking. Do you have them with you? *Any injuries, past or present? E.g. ankle, back, shoulder, finger etc *YesNoList all areas of your body that have (or have had) injuries, along with the nature, frequency and recovery of the injury. *Declaration *I, the participant (or parent/guardian of), confirm the information supplied in this form is correct, and I accept full responsibility for the information given and any effects this may have while participating in any events.Participant's Name (or parent/guardian if under 18) *FirstLastSubmit