Pre-trip – Big Severn adventure

Please complete one form per participant before departure. This information helps us plan safely, prepare suitable food and respond appropriately in an emergency. If anything changes before the trip, please let Nigel know.

Participant details

Tell us who is completing this form.

Full name *

Date of birth *

Mobile number *

Email address *

Home address *

Medical information

Please give enough detail for us to support you safely.

Do you have any medical conditions, disabilities, injuries or health concerns that could affect you during the expedition? *

No Yes

Please provide details *

Do you take any medication that may be relevant during the trip? *

No Yes

Medication details *

Do you have any allergies? *

No Yes

Please describe the allergy, likely reaction and treatment required *

Do you carry emergency medication such as an inhaler, EpiPen or glucose treatment? *

No Yes

What do you carry and where will it be kept? *

Is there anything else we should know to support you safely during the trip?

Please bring enough medication for the full expedition and keep essential medication accessible and protected from water.

Dietary requirements

This helps us plan meals for the whole group.

Dietary requirements *

Please tell us your dietary requirement *

Do you have any food allergies or intolerances? *

No Yes

Please provide details and explain how serious the reaction could be *

Are there any foods you cannot or will not eat?

Emergency contact

This must be someone who is not taking part in the expedition.

Full name *

Relationship to you *

Primary telephone *

Alternative telephone

Email address

Home address (optional)

Experience and water confidence

There are no right or wrong answers. This simply helps us support the group.

How would you describe your canoeing experience? *

Are you confident being in or around deep water while wearing a buoyancy aid? *

Yes No Unsure

Can you swim? *

Yes No Limited ability

Is there anything about the paddling, camping or expedition that concerns you?

Participation confirmation

Please confirm each statement before submitting the form.

I understand this is an outdoor, multi-day canoe expedition involving physical activity, changeable weather, camping and time in remote locations. * I will follow safety instructions and decisions made by the trip leaders. * I will tell the trip leaders if I feel unwell, become injured or feel unable to continue safely. * I will inform Big Severn Adventure if any information provided on this form changes before departure. * I confirm the information I have provided is accurate and complete to the best of my knowledge. *

Emergency assistance

This allows the trip leaders to act if you cannot communicate during an emergency.

If I am unable to communicate during an emergency, I authorise the trip leaders to provide relevant information to emergency services and seek appropriate assistance on my behalf. *

Photograph preference

Your choice will not affect your participation in the expedition.

Photographs and video may be taken during the expedition. Please select your preference. *

I am happy to appear in photographs or video used by Big Severn Adventure. Please ask me before using identifiable photographs or video. I do not want identifiable photographs or video used.

Declaration

Typing your name confirms the declarations above.

Type your full name *

Date completed *

Send your completed form

After submission, a copy of your answers will be emailed to you. Big Severn Adventure will also receive a clearly formatted copy for expedition planning.

The information supplied through this form will only be used for trip planning, participant support and emergency response.

Thank you. Your participant form has been received.

A confirmation showing the information you submitted has been sent to your email address. If anything changes before the expedition, please contact Nigel as soon as possible.