MEDICAL DECLARATION/CONSENT FORM

Please fill out the following form to help us understand your physical condition.

Answering YES to any of these questions below will not necessarily preclude you from joining your session

Please tick if you currently:
Please tick if in the last five years you have had any:
Please tick if you have ever suffered from:
Please tick if you are afraid of:
Are you a non-swimmer (i.e. cannot swim a minimum of 50m un-aided?
Do you need to elaborate on any of the ticked answers above or have any other converns about this session related to your health and well-being?

Thanks for submitting!