Medical Statement

Please complete this before your tour if any of the conditions below apply to you. This takes about two minutes and helps us keep you safe on the day — most guests fill it out when we meet at the van, but if you're 60+ or have a health condition, doing it online in advance gives time to sort out anything that comes up.

Section 1

Any "Yes" here means we can't take you on the tour — please contact us directly to talk it through before booking.

Unable to walk 1 mile (1.6km) within 12 minutes?

Are you pregnant?

Any form of lung disease?

Pneumothorax, other chest disease, or chest surgery?

Head injury with loss of consciousness in the past 5 years?

Any heart disease, heart surgery, or heart attack?

Thrombocytopenia or other blood disorders?

Colostomy or ileostomy?

Epilepsy or conditions causing sudden unconsciousness?

You've answered "yes" to a Section 1 question. We're not able to take you on the tour as things stand — please contact us directly so we can talk it through.

Section 2

A "Yes" here means you'll need medical clearance from a doctor before joining — it won't stop you from submitting this form.

Currently taking any prescription medication?

Under any medical care in the last 12 months?

High cholesterol?

High blood pressure, or medicated for it?

Diabetes, even if diet-controlled?

Asthma, or wheezing with breathing/exercise?

Behavioural or mental health conditions (panic, fear of closed/open spaces)?

Dysentery or dehydration?

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

Ulcer or ulcer surgery?

Recreational drug use, or alcoholism treatment in the past 2 years?

Raynaud's syndrome?

Vertigo or dizziness?

Cancer?

Age 60 or older?

You've answered "yes" to a Section 2 question — you'll need medical clearance from a doctor before joining. Submit this form and we'll email you the physician approval form to bring along or send back to us.

Your details

Full name Tour date

I confirm the information above is accurate to the best of my knowledge, and I accept responsibility for any omission resulting from my failure to disclose an existing or past medical condition. Typing my name below and submitting this form serves as my signature.

Signature