Hillary Challenge 6hr Medical/Consent Form
Please fill in a separate form for each team that you are bringing to the event.
School Name (or names if combining with another school)
Please include a unique name/number for this team, if you are bringing more that one team to the event.
Please choose the event for which you are filling in this form.
30 August - North Island
6 September - South Island
Name of manager accompanying the team
Phone number of accompanying manager
Email of team manager
We need to know the following information for every student attending the event. Each students name and email (will be added to our alumni database) and any medical conditions and/or pre-existing injures that might affect their participation in the event. Also, if the student is currently taking any medication and is confident in the water and able swim at least 50m.
Medical conditions (detail)
Pre-existing injuries (detail)
Taking medication (detail)
Can swim 50m (Y/N)
Disclosure of Risk
The Hillary Challenge 6hr is a non-profit event organised by Hillary Outdoors Education Centres with the help of local volunteers and organisations around the country. Hillary Outdoors coordinates the entries from schools, designs the course and provides event information to the registered teams and volunteers and organisations assisting with each event. It also provides the assistants with generic hazard management and briefing information and the framework for scoring the challenges. As part of the Hillary Challenge 6hr events students will be involved in challenges based around the outdoor pursuits of Orienteering/rogaining, Mountain biking, where they will be with their team only and not directly supervised at all times. There will be marshals at several points on the course but he students will ultimately be responsible for managing the safety of themselves and their team mates when unsupervised. At some events there will also be various land and water based problem solving challenges. These will be supervised by an appropriately skilled adult. At some events there may be a water element/challenge involving kayaks, canoes or stand up paddle boards. These will be supervised by an appropriately qualified adult. All of the activities contain some element of risk and this risk is countered by comprehensive safety briefings and through supervision by experienced adults when required. It is important for safety purposes that students follow instructions given to them in the briefings. Participation in all activities at the event is voluntary. It should also be realised that because of the changeable and unpredictable nature of the outdoors, that the risk can never be reduced to zero. Hazards exist in these activities that may result in serious injury or even death. The types of hazards include: Orienteering, Mountain biking, slippery conditions, uneven ground, heights, cold and changeable weather, high winds, hypothermia, hyperthermia, sunstroke/sunburn, dehydration, water environments, moving at speed e.g. when cycling.
Acknowledgement of Risk
It is understood that there are certain risks associated with outdoor activities in the Hillary Challenge 6hr events that cannot be reduced to zero. We know that we are able to ask any questions of Hillary Outdoors or the experienced adults running a challenge to gain a better understanding of the activity before deciding whether to take part, and that the final decision about whether to take part or not, is over to each individual. If we decide to take part, we understand that the experienced adult running each challenge will identify any hazards that are likely to arise and disclose the correct procedures to deal with these, and that it is necessary for us to follow these. If the experienced adult has taken all reasonable precautions to ensure our safety, and we act outside of this advice, then we acknowledge that we do so at our own risk and we release Hillary Outdoors and all members of the assisting clubs and organisations from liability for the consequences of our actions. It is understood that photos and/or videos may be taken of us during the event and possibly used for general promotion and in social media posts by Hillary Outdoors and event sponsors.
Team manager please add your name here to acknowledge that you have read and understood the risks associated with this event and that your students have been briefed on these risks prior to participation.
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