Medical/Dietary Form - OYT Scotland

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Please read the below statement carefully and tick the bottom of it to confirm you have read and understood it fully.

Adventure under Sail is a fun, exciting and challenging activity that provides many benefits to those that take part. Safety at sea is our priority and we are proud of our safety record over the last 50 years.

Sailing can be strenuous and we train participants from the outset to minimise the risk of injury. However accidents can still happen and seasickness can impair ability to take oral medication, fluids and food.

Our sea staff have been trained in basic first aid and our boats have some medical kit. They are not equipped though to deal with major illness and we may, very occasionally, need to arrange for crew to be transported ashore for medical assistance. Please be aware that, unlike on land, where an ambulance can be expected in 10 mins this may take several hours. This may affect outcomes.

This can be particularly important for participants who suffer from diabetes, asthma, allergy, epilepsy or other significant conditions requiring urgent help. Please take time to fill in the following medical questionnaire accurately, well in advance of your voyage. We may need to make further enquiries and arrangements to ensure all of our crew are as safe as possible.

This ensures that our Skippers and First Mates will be fully briefed about any medical needs.

If any of your details change after completing this form and before your voyage start date please give us a call on 01475 722 722 ASAP to update them.

Please select *

I agree

Personal Details

Title

First Name *

DOB *

Pronoun

Surname *

Nationality *

Email Address *

Gender *

Female Male Non-binary Prefer not to say

Mobile Phone *

(44 replaces the 0 at the start of your number)

No Mobile Number

No mobile number?

Landline

If you don’t have a landline – please leave this blank.

Address

Address Line 1 *

Address Line 2

City *

Postal Code *

Information

Waterproof Size *

Photo

Here you can upload a recent photo of yourself. Please avoid group-photos where more than one person is pictured. (optional)

24hr Contact Details

Please note: The 24hr contact must be in the country during any sailing dates and must be contactable 24hrs a day.

Full Name *

Relationship *

Mobile Phone *

(44 replaces the 0 at the start of the number)

NOK No Mobile Number

No mobile number?

Landline

If they don’t have a landline – please leave this blank.

24hr Contact Address

Address Line 1 *

Address Line 2

City *

Postal Code *

Medical Information

Doctor’s Name / Surgery *

Doctor’s Telephone Number *

Do you have asthma? *

Yes No

Do you have a diagnosed heart condition? *

Yes No

Do you have epilepsy? *

Yes No

Are you diabetic? *

Yes No

Have you fainted or had a blackout in 2 years? *

Yes No

Do you sleep walk? *

Yes No

Have you been medically diagnosed with migraine? *

Yes No

Have you been diagnosed with ADHD, ADD or similar condition? *

Yes No

Have you been diagnosed with a mental health condition? *

Yes No

Have you been diagnosed with Asperger’s syndrome, autism, Tourette’s Syndrome or similar conditions? *

Yes No

Do you have any recurring health conditions not already mentioned? *

Yes No

Allergies to any known drugs or medicines including penicillin? *

Yes No

Any other allergies eg materials, insect bites, (not food) *

Yes No

Do you consider yourself to have a disability or health condition? *

Vision

Hearing

Mobility

Dexterity

Learning or understanding or concentrating

Memory

Stamina or breathing or fatigue

Socially or behavioural

None of the above

Other

Are you taking any regular medication within the last 6 months that you haven’t told us about? *

Yes No

Have you had any recent contact with contagious diseases or infections? *

Yes No

Are you receiving treatment from either your family doctor, hospital or specialist that you haven’t already mentioned? (eg physiotherapy, specialist clinics, etc) *

Yes No

Have you been given specific medical advice to follow in medical emergencies? *

Yes No

Do you have any condition that you feel would require assistance whilst on the voyage? *

Yes No

Do you have any dietary requirements or food allergies? *

Yes No e.g. Halal, Vegetarian, Vegan, Pescatarian, Cosher, Coeliac etc.

Is it likely that you might be pregnant during the voyage? *

Yes No

Please include any additional information or issues of medical, behavioural or other conditions which might affect the performance or safety of the applicant. Depending on the medical condition, you may be asked to provide a doctor’s note (we will be in touch if this is required).

You must also inform us of any changes to the answers given above before the start of the voyage.

Please give details of any additional support needs (leave blank if not applicable)

More information

Equalities

What is your ethnicity? *

White – Scottish

White – Irish

White – Other British

White – Polish

White – Roma

White – Gypsy/traveller

White – Showman/Showwoman

Mixed or multiple ethnicity

Pakistani, Scottish Pakistani or British Pakistani

Indian, Scottish Indian or British Indian

Bangladeshi, Scottish Bangladeshi, British Bangladeshi

Chinese, Scottish Chinese or British Chinese?

Other Asian ethnicity

African, Scottish African or British African

African – other African ethnicity

Black – Caribbean

Black – Other black ethnicity

Arab, Scottish Arab, British Arab

Other ethnicity not listed above

Prefer not to say

What is your religion or belief? *

None

Church of Scotland

Roman Catholic

Other Christian

Muslim

Hindu

Buddhist

Sikh

Jewish

Pagan

Other

Prefer not to say

What is your sexual orientation? *

Straight/ heterosexual

Gay or lesbian

Bisexual

Other

Prefer not to say

What is your marital status? *

Married

In a civil partnership

Divorced

Separated

Widow

Other

Prefer not to say

What is your parental status? *

Parent

Not a Parent

Prefer not to say

Is the gender you identify with the same as your gender registered at birth? *

Yes

Prefer not to say

Consent

Can the applicant swim? *

Yes No

I consent for the applicant to participate in supervised swimming/paddling activities *

Yes No

I confirm that I can be featured in Photographs *

Yes No

If you wish to hear from us again please tick one or more of the following options.

Sailing Volunteering Supporting Newsletter Your data will be stored inline with GDPR 2018, unless stated otherwise.

I have provided details of any medical condition, which might affect the performance or safety of the applicant or others *

Yes No

I consent to the applicant being given emergency medical treatment, including the administration of anesthetic should it be necessary, and authorise OYT Scotland staff to give such permission as may be necessary for such treatment to proceed. *

Yes No

I consent to the applicant taking part in a voyage with Ocean Youth Trust (Scotland) Ltd. *

I agree

I agree to the Terms & Conditions *

I agree

Click here to view the Terms & Conditions

Are you completing this form on behalf of someone? *

Yes No

Monitoring

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