We are required to ensure every participant fills in these details for safe operation of our courses, events and membership.
Will you require a neoprene salopette? ---NoSmallMediumLargeExtra Large
Will you require a neoprene jacket? ---NoSmallMediumLargeExtra Large
Helmets are compulsory, will you require a helmet? ---No, I will use my ownSmallMediumLarge
a. Have you ever suffered from epilepsy or unexplained loss of consciousness? YesNo
b. Do you have asthma? YesNo
c. Do you have diabetes? YesNo
d. Have you ever been diagnosed with angina, suffered a heart attack or any other heart condition? YesNo
e. Do you suffer from any musculoskeletal problems, such as back or neck pain? YesNo
f. Do you have a medical condition not covered in the above? YesNo
g. Do you have any mobility issues you feel could impact your course? YesNo
h. Do you have any other issues you feel could impact your course? YesNo
i. Can you swim more than 50m unaided? YesNo
Do you give consent for any photographs taken during the course, to be used for social media and marketing purposes? YesNo
Do you consent to the above information being used to contact you regarding upcoming courses, promotions and offers? YesNo
By providing a Start and Finish Date, I understand that for the duration of the stated time this Information shall be used and understood by Provela to be correct. Should this information change within the dates stated I shall inform Provela as soon as possible. If I do not inform Provela of any changes I understand that they are not liable.
I have read and agree to the Provela’s Terms and Conditions. I also consent to the above details being used to contact me. Read T&C's
I declare that the responses I have provided above are correct to the best of my knowledge and I know no reason related to my health and well-being that will prevent me from undertaking this course. I will inform the Instructor immediately should I have any difficulties during the course.