This form is required for registration at BUCS/BUSA Sailing Championships.

This information will only be used for the academic year 2017-18.  It is the sailors' responsibility to update/re-complete their information if their medical information changes during the course of the year. This information will be kept confidential and will not be shared with third parties, however it will be shared with the BUSA Event Director for each championship.

* 2. Name (Please ensure that your name is spelt correctly and matches how it has been entered on BUCScore)

* 3. What is your date of birth (DD/MM/YYYY)

* 4. Gender

* 5. Address

* 6. Email address

* 7. Mobile number

* 8. Name and mobile number of your next of kin (to be contacted only in the case of an emergency)

* 9. Do you have any medical conditions you need to make us aware of? (including allergies) Failure to declare any medical conditions could make your entry to an event invalid.

* 10. Please list any medication(s) you are currently taking.

* 11. If there is any other medical information you feel the event organisers should have, please provide here:

* 12. DECLARATION:

  Yes No
I understand that it is my responsibility to make known any medical conditions or injuries that may affect my personal safety during the activities associated with any event I enter.
I understand that it is my responsibility to update the event organisers if any of the above medical information changes prior to or during the event.
I consider myself physically fit to take part in the events I am entering and water confident in light clothing with a personal floatation device.

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