Medical Declaration

OCRDA Medical Declaration

This information is used purely for your own safety and passed only to paramedics/hospitals IF/as required.
Part A - Competitor Details
Your Name

First NameLast Name
Date of Birth

DayMonthYear
Your Mobile:
Age at 01.04.25
Your Email
example@example.com
Age Calculation Date

DayMonthYear
*Licence No*.
Address

County
OCRDA DECLARATION MEDICAL FORM

1. Data Protection: The information collected on this form will be used by the Organising Association for dealing with you as a participant in the Event and for administration of the Event. In the case of incident or an emergency, the Organising Association may disclose this information to the Emergency Services/a Medical Professional.

2. This form is designed to be completed by yourself and does not require to be signed by your Doctor. However, if you have doubts about any aspect of your fitness (including eyesight), you may wish to discuss these with your Doctor before you complete this form.

3. If you select "Yes" for any of the questions or you have added qualifying remarks, your form may require further assessment by a Medical Professional.

Any assessment may initially be in the form of a telephone call enquiry .

4. It is your personal responsibility not to start in or to continue to participate in a powerboat/jet ski/pro cat race if you are or become temporarily or permanently unfit to do so for any reason.

6. OCRDA reserve the right to suspend participation in an event/s if they feel the individual is unfit to race for whatever reason, regardless of the issuing authority of the licence holder.

Part B - Medical Admin

Rows	Yes	No
i have completed the required OCRDA medical conducted by a medical professional
I agree to allow OCRDA paramedics to carry out emergency aid to myself if required

Part C - Medical History

Rows	Yes	No
Are you taking any medication on a regular basis (prescribed or non-prescribed)?
Do you have any allergies?
Do you have any other condition which could have an adverse effect on your ability to participate in the Event?

Blood Type if know. (if not leave blank)
If you have entered YES to any of the above questions, you MUST please provide details below.

If you have not entered YES please enter NONE in the box below.
If you have entered YES to any of the above questions, you MUST please provide details below. If you have not entered YES, please enter NONE in the box below.
Supporting Information for any YES responses to medical declaration OR write NONE
If you take any medications, have any allergies or any medical conditions that a Paramedic or Emergency Department would need to be aware of, please enter the details in the box below.

If you take no medications, have no allergies or medical conditions that a Paramedic or Emergency Department would need to be aware of, please write NONE in the box below.

(The box can not be left empty)
Enter any medications, allergies or medical conditions above OR write NONE - *You are responsible for declaring any Allergy/Medical Condition/Medications so that these details can be provided to any Medical Officer in the event that you should require Medical Assistance*
PART C - DECLARATION

I declare that I have checked the details given on the above form and that to the best of my knowledge and belief they are true and correct. I also authorise the OCRDA to disclose the information in this form to an independent Medical Professional Assessor/Emergency Services if deemed necessary.

If anything changes during the racing season from the information provided in this form, I will immediately inform OCRDA by emailing admin@ocrda.com

I also confirm that I carry sufficient personal accident cover for my needs and certify that this is the case.
I, the undersigned, confirm that I have personally completed this form and that the information provided herein is true and accurate to the best of my knowledge. I understand that providing false information renders the form invalid and could result in removal of my membership.
Signature
Should be Empty:

OCRDA Medical Declaration