Duke Of Edinburgh ExpeditionMedical Information and Risk Acknowledgment FormWe Look Forward to Seeing You SoonPlease have every member of your group fill in this form (You have to refresh the page after submitting each person) Name * First Name Last Name Date of Birth * MM DD YYYY Personal Fitness Level (self evaluation) (Scale 1= I have little experience of walking for longer than 5 hours, 5 = I regularly hike and have been up several mountains) 1 2 3 4 5 Email * What is your DofE ID Number (found in the DofE App) * What is the centre you are doing your DofE with? (School name, Scout group, Organisation) * Which Expedition are you booked on to? * 25th-28th August 2025 - Dark Peak Is this your practice or qualifier? * Practice Qualifier Phone * (###) ### #### Name of Emergency Contact * First Name Last Name Emergency Contact- Phone Number * (###) ### #### Do you have any mental health conditions or challenges that might affect your participation in this activity? (This information will be used confidentially to ensure your safety and appropriate support.) No, I do not have any mental health conditions that may affect my participation. Yes, I have experienced anxiety or panic attacks. Yes, I have a diagnosed mental health condition (e.g., depression, bipolar disorder, etc.). Yes, I have experienced trauma or PTSD. Yes, I have a neurodivergent condition (e.g., ADHD, autism, etc.). Yes, I experience phobias or fear-related conditions (e.g., fear of heights, enclosed spaces). Yes, but I prefer not to specify. Relevant Medical Conditions (e.g., asthma, diabetes, heart conditions) Do you have any medical conditions that may impact you during this event or that may need to be passed on to a medical professional in an emergency? If Yes to above, Would you like to discuss your needs or receive additional support for this activity? Yes No Allergies (e.g., food, insect bites) Any allergies must be passed on including food and medicine Physical Limitations or Injuries (e.g., joint issues, mobility challenges) Consent to Share Medical Information with Leaders in Case of Emergency * Yes I consent to the use of photos and media of me on Summit Explorers social media (terms and conditions) * Yes No Acknowledgment of Risk By participating in this guided walk or DofE Activity, I acknowledge and accept the following: Inherent Risks: I understand that outdoor activities involve inherent risks, including but not limited to uneven terrain, slips, trips, falls, changing weather conditions, and other natural hazards. Personal Responsibility: I confirm that I am participating voluntarily and take full responsibility for my own actions, including ensuring I wear appropriate clothing and footwear for the activity. Fitness and Health: I declare that I am physically fit and have disclosed all relevant medical conditions or limitations that could affect my ability to participate safely. Leader Guidance: While the walk is led by a qualified Mountain Leader, I understand that my safety cannot be guaranteed, and I agree to follow all instructions provided by the leader during the walk. Emergency Situations: I consent to receiving first aid or emergency medical treatment if required during the walk. Liability: I accept that the organizer and leaders are not responsible for any injury, illness, loss, or damage sustained during the walk, except where caused by negligence. By checking this box, I confirm that I have read, understood, and agreed to the above statements and that I am fit and prepared to participate in the walk. * Yes Thank you!
