Health declaration

01

About you

Full name

Date of birth

Mobile

Email (optional)

You're joining as

Shoot date

Production or company (optional)

02

Emergency contact

Someone we can call if you're unwell or hurt. Not someone coming on the boat with you.

Their name

Relationship to you (optional)

Their phone

03

Your health

Do any of these apply to you? A yes rarely stops anyone coming aboard. It means the skipper knows what to look out for.

Heart condition, high blood pressure or chest pain NoYes

Epilepsy, seizures, fainting or blackouts NoYes

Diabetes NoYes

Asthma or another breathing condition NoYes

Back, neck or joint problems, or an injury or operation in the last six months NoYes

Are you pregnant? NoYes

A severe allergy, for example one you carry an adrenaline pen for NoYes

Medication that can make you drowsy or affect your balance NoYes

Anything else we should know, such as hearing, sight, mobility or mental health NoYes

Tell us a little more Anything you answered yes to, and what we should do if it flares up.

Medication or medical kit you'll bring (optional) For example an inhaler, adrenaline pen or insulin.

Can you swim? Yes, confidentlyA littleNo

Do you get seasick? NoYesNot sure

04

Your declaration

What I've told you is true and complete. If anything changes before or on the day, I'll tell the skipper. I won't come aboard under the influence of alcohol or drugs. I'll wear the lifejacket I'm given and follow the skipper's and crew's safety instructions at all times. In an emergency, I agree to receive first aid, and for this information to be shared with the emergency services treating me. I agree to Cinecraft using my health information to keep me safe on this shoot, as set out below.

How we look after your answers. They go over an encrypted connection to the Cinecraft team's phone, through a messaging service we use for this, and are not stored on this website. Only the skipper and the team running your shoot see them, plus the emergency services if you need help.

We delete them 30 days after the shoot, unless there was an incident we have to keep a record of. You can withdraw your consent or ask what we hold at any time: hello@cinecraft.uk or 020 3039 3931.

You're under 18, so a parent or guardian needs to fill this in too.

Parent or guardian's name

Their phone

I'm their parent or guardian. I've checked these answers and I agree to the declarations above on their behalf.

Type your full name to sign