Medical form

1. Your full name
2. Name of Lead Customer (if part of group booking)
3. Voyage
5. Date of birth:
   1. Day (1 - 31)
   2. Month (1-12)
   3. Year

Voyages with VentureSail should be a pleasure, however the sea is a natural and unpredictable environment. We regret that there are some conditions that, even if ‘under control’ on dry land, can become critical at sea and threaten the safety of the individual or the vessel. If you answer “Yes” to any questions in Section 1 we may, regrettably, not be able to accept your booking on certain vessels. All such decisions are final and we will of course explain why we have made the decision.

1. Would you have any difficulty climbing a 2m ladder at sea OR getting in or out of a dinghy or small boat?---YesNo
2. Are you diabetic? ---YesNo
   1. What type of diabetes do you have?---Type 1Type 2
   2. Do you inject insulin?---YesNo
   3. Have you ever had hypoglycaemia (“a hypo”) ---YesNo
3. Are you a pregnant female?---YesNo
   1. How many weeks pregnant will you be on the last day of the voyage you are booking? Please round up to the nearest week.
4. Do you suffer from sleep apnoea or use a CPAP machine?---YesNo
5. Do you suffer from severe vertigo, or motion sickness or have any problems with balance that may cause you to need assistance?---YesNo
6. Have you ever suffered from epilepsy or other forms of seizure?---YesNo

These are other conditions that must be disclosed to us at the time of booking. For certain vessels and voyages accepting your booking may be at the discretion of the owner or skipper of the vessel. In relation to any condition additional information may be required from your doctor.

1. Do you suffer from asthma, or have any difficulty breathing?---YesNo
   1. Please tell us how this is controlled.
2. Do you have high cholesterol or use anti coagulants?---YesNo
   1. Please tell us how this is controlled.
3. Do you have high blood pressure or any other heart problems?---YesNo
   1. Please tell us how this is controlled.
4. Do you have any past medical conditions? ---YesNo
   1. Please tell us what it was, how long you had it, and how long it has been since it affected you.
5. Have you been admitted to hospital as an ‘in patient’ in the last 5 years? ---YesNo
   1. What was this for; and what treatment was required?
6. Do you have an allergy to any food, or medicine, or anything else?---YesNo
   1. What is it/they and how does it/they affect you?
7. Do you have any sight problems except those that are rectified by glasses or contact lenses?---YesNo
   1. Please tell us what they are and how they affect you, in detail.
8. Do you have any other health issues we should be made aware of?---YesNo
   1. Please tell us what they are and how they affect you, in detail.
9. Do you have any mobility issues we should be aware of? ---YesNo
   1. Please tell us what they are and how they affect you, in detail.

Please tell us about any medication you are taking now, or expect to be taking at the time of your voyage. Please note we may need to request additional information from your doctor.

1. Are you taking any regular medication?---YesNo
   1. Please list the medication and dosage
   2. You must bring all medication with you including extras in case of delay or loss, as well clear written instructions on dosages and how the medication should be taken. Your skipper must be make aware of all medication brought on board, whether ‘prescription’ or otherwise.

We need information about your health and medical conditions, some of which may be personal, for important safety reasons. Information will not be shared with any other organisations except the owners or managers of the vessel on which you will be sailing. All health and medical information given to VentureSail will be used in strict confidence, will be stored securely, and will be destroyed within 3 years of the end of your voyage.

I confirm that the information given is accurate and complete, and I understand that:

1. Some medical conditions may make a sailing holiday inadvisable and that my booking may be refused.
2. VentureSail must be made aware immediately, and prior to joining the vessel, of any changes to my medical conditions.
3. The skipper or owner of the vessel has the right to refuse to accept me on the voyage if not fully satisfied about any matters regarding health or safety.
4. If I fail to disclose any information I am fully liable for any cost and expense that falls due, in relation to but not limited to; being put ashore, transferred to another vessel, associated travel costs, delays to the voyage schedule, or repatriation.

1. Name
2. Date
3. I confirm that all details are correct