Yorkshire Three Peaks Medical Participation Form

Name*
Emergency contact 1*
Emergency contact 2*
Do you have sore joints that could worsen by undertaking this activity?*
Have you had or do you have epilepsy or are you concerned in any way that you may have it?*
Do you carry an EpiPen?*
Are you pregnant?*
Do you have any cold or flu-like symptoms?*
Do you suffer from vertigo/are you afraid of heights or rocky scrambles?*
Have you suffered from circulatory issues such as deep vein thrombosis?*
Do you have any health issue we need to know about prior to you taking part?*
Have you been diagnosed by a doctor or health professional with any of the five following medical conditions?
Consent*
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