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Health Declaration

Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.
To enjoy the great outdoors and participate in our experiences safely, you should not be extremely overweight or severely out of shape/condition, some of the experiences we conduct can be strenuous under certain conditions
Your respiratory, circulatory system and muscular/ skeletal function should be in good stead. Aperson with coronary disease, epilepsy, a severe medical problem will need to get a doctor'spermit to participate in our experiences. A person who is under the influence of alcohol or drugswill not be allowed to participate and the organisers hold the right to deny them the same.
The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in our recreational experiences. This is not an exhaustive list, but to assist you in evaluation of pre-existing medical conditions.
A positive response does not disqualify you from participation.

First name

Last name

Email

Please respond to the following questions based on past or present.

Asthma, or wheezing with breathing or wheezing with exercise? *

No

Yes

Any form of lung disease? (past or present, including Covid-19) *

No

Yes

Any other chest disease or chest surgery? *

No

Yes

Any behvioural health, mental health or psychological conditions? *

No

Yes

Epilepsy, seziures, convulsions or take medications to prevent them? *

No

Yes

Ever had blackouts/fainting (full/partial loss of consciousness)? *

No

Yes

Inability to perform moderate exercise (e.g.: walk 1.6kms/1 mile in 15 mins)? *

No

Yes

Back, arm or leg problems following surgery, injury or fracture? *

No

Yes

Do you have high blood pressure or take medication to control the blood pressure? *

No

Yes

Have you ever had heart disease / heart attack or undergone any cardiovascular procedure (stenting/bypass etc.0? *

No

Yes

Date

Initials

I confirm that the information given in this form is true

Thanks for submitting!

Waterfall trek in North Goa

Waterfall trek in South Goa

Kayaking in North Goa

Nature walk in North Goa

Nature walk in South Goa

Cycling Trips in North Goa

Beatroute Explorers,

B-5, Satapori Heights, Moide, Mapusa, Goa 403507

Terms & Conditions

Booking & Cancellation Policy

Health Declaration Form

©2024 by Beatroute Explorers.

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