Outdoor Leadership Participant Medical Record


Personal Details













Emergency Contact Details








Medical Details

Do you have any of the following?
Check all that apply.







Have you ever suffered from, or now suffer from, any of the following?
Check all that apply.

















































Swimming Ability: *

Acceptance of Risk

I have accurately and honestly completed this medical form.

I understand that outdoor leadership focuses on the development of my physical skills as well as the | theoretical understanding of the subject matter.

I understand the activities involved in this class, and I am confident that I will be able to participate in the physical activities.

I confirm that I have no previous injuries or illnesses that would limit my involvement.

I realise that engaging in these activities will place me at risk at times. I also understand that I can reduce the level of risk to myself by:
  • following the directions of my instructors
  • using my common sense
  • electing to apply the principle of challenge-by-choice (providing this does not endanger me or other participants or leaders).

I understand that outdoor settings could present a variety of dangers to me and that despite thorough planning and all possible care, accidents can occur. In the unlikely event that I suffer injury or illness, I agree that the organisers can arrange medical treatment and emergency evacuation services as they deem necessary for my safety or well-being.

I understand the activities associated with this class are potentially dangerous. I knowingly accept the risks to which I will be exposed and agree to release to the full extent of the law Avondale University Ltd, its employees and agents from responsibility for any injuries I may suffer due to my participation.

I acknowledge that my information to Avondale University on this form is complete and accurate, and I will inform the activity leader if there are any changes.






IMPORTANT: Upon submitting this form, you will receive a confirmation email. If you do not receive the email, contact Student Administration Services by emailing [email protected] or call +61 2 4980 2377.