Poole Inclusive Paddleboarding Experience Booking medical form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastMobile Number *Email *Address – including Postcode *Gender *MaleFemaleAge range * 18-29 30-39 40-49 50-59 60-69 Emergency Contact Name (This should be someone we can contact in an emergency, not someone who is on the event with you) *Emergency Contact Number *Doctor / General Practitioner (GP) Name *Doctor / General Practitioner (GP) Address *Doctor / General Practitioner (GP) Telephone number *Are you a (please tick the relevant box)ParticipantCarer, friend/family member of a participantIf you to bring a family member, friend or carer are they:Able to assist you to get on the waterComing out on the water with youUnable to assist and planning to observe from the shoreApproximate height in cmApproximate weight in KG's (For deciding on board and wetsuit size if needed)Swimming Ability (Your answer does not affect your ability to attend our event. It's just for our reference.)I can you swim 25 metres?I can you swim 50 metres?I can float independently in deep water?None of the aboveDo you have any previous paddleboarding/ watersports experience?Yes a littleYes a littleYes a LotNoneGeneral Health: Do you have any of the following, that would impact your ability to paddleboard. (Please tick all relevant boxes)Visual impairmentHearing impairmentSpeech impairmentPhysical impairmentCognitive impairment (learning difficulty)Medical conditionMental health conditionIf you tick any of the boxes above, please can you tell us how they might affect your ability to go paddleboarding?Known Allergies – Please provide a list of substances including any drugs / foodstuffs and other substances to which you have suffered an allergic reaction to at any time. Medication – Please give details of any medication required. If you require any medication during the journey/visit, it is your responsibility to provide this medication. An adequate supply must be provided to cover the whole trip if necessary.What support will you need to ensure we can get you out on the water safely and comfortably and can communicate with you effectively. Please select the amount of support you might need for each question belowLocating the centreNo SupportSome SupportFull SupportFilling out & signing formsNo SupportSome SupportFull SupportChanging into paddleboarding clothingNo SupportSome SupportFull SupportTrying different paddleboarding equipmentNo SupportSome SupportFull SupportGetting to the water via the tarmac path (approximately 100m)No SupportSome SupportFull SupportTransferring onto a paddle boardNo SupportSome SupportFull SupportHolding a paddle with both handsNo SupportSome SupportFull SupportPaddle in a designated areaNo SupportSome SupportFull SupportFollowing verbal instructionsNo SupportSome SupportFull SupportPractising a paddleboard self rescueNo SupportSome SupportFull SupportWe have a range of seats and kneeling supports to help you paddle in safety and comfort. Do you think you would prefer to:Sit in a seat with back and lateral supportUse a kneeling seat supportTry both and see what works for meI’m not sureAre you currently receiving any medical treatment?YesNoMedical Treatment. If you answered Yes, please give details of the treatment and how it might affect your ability to paddleboard. Booking details How or where did you hear about us?Live well DorsetDorset Well Being HubSocial MediaWord of mouthMedical ProfessionalOtherWhich days and time are you available to go paddleboarding?Tuesday MorningTuesday AfternoonWednesday MorningWednesday AfternoonThursday MorningThursday AfternoonNone of the abovePhotography , filming and Marketing. From time to time, photographs and video may be taken of clients participating in activities. These photographs and videos are used for training and marketing purposes only. Are you happy for us to use photos and films for the purposes of training and marketing?YesNoIn accordance with National Governing Body guidelines, Poole inclusive paddleboarding experience recognises that paddlesports are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions.Yes, I agreeNo, I do not agreea) warrant that the information given is correct to the best of my knowledge; b) give my consent as the above-named person to receive medical treatment and care from either Doctors or First Aid Qualified Staff where necessary; c) agrees to Poole inclusive paddleboarding experience making any further enquiries, in light of information given, that it considers necessary to establish whether the participant is medically fit to participate in the visit referred to in this booking. In the event of Poole inclusive paddleboarding experience deciding, in its absolute discretion, that the participant is not medically fit to participate, I understand that any sum paid by me in respect of any costs or expenses of the journey will be refunded to me in full (less a deduction covering administration expenses and deposit). Submit