Namib Race / UltraLite (Namibia) 2026 - Medical Information & Emergency Contacts

  • NAMIB RACE / ULTRALITE (NAMIBIA) 2026 - EMERGENCY CONTACT & MEDICAL FORM

  • You must answer the questions in this form accurately. It will be shared with our medical director to review before the race.

    Based on the information provided in this form, we may request additional information or deny your participation in the event.

    If we do not receive this form with adequate advance notice, you may not be allowed to participate.

    DEADLINE FOR SUBMITTING: 19 June 2026

    NOTE: The red asterisk (*) denotes a required field.

  • Personal Details

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  • Date of Birth*
     / /

  • Emergency Contacts

    You must provide two contacts
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  •  -

  • Risk Acknowledgements

    If any of the conditions are left unconfirmed you will not be able to submit your form. Please familiarise yourself by thoroughly researching each condition.

  • The 4 Deserts Ultramarathon Series, RacingThePlanet Ultramarathons and RacingThePlanet UltraLite are footraces up to 250 kilometers / 155 miles long that take place in some of the most extreme and hostile environments in the world. There are medical risks associated with taking part in these races, and every participant must be aware that they could develop a medical condition. The list below includes some of the risks. Please check each box to confirm that you are familiar with the following medical conditions and understand the symptoms.

  • I confirm that I am familiar with the following conditions, and I understand the symptoms & risks:*

  • Health Profile / Fitness Evaluation

    If you have no conditions / allergies / medications to declare please type N/A
  • Do you have any medical conditions?*

  • Condition 1:*
    Medication Required:  *     

  • Condition 2:
    Medication Required:       

  • Condition 3:
    Medication Required:       

  • Are you currently taking any medications?*

  • Medication 1:*
    Dosage:  *   
    What for:*   

  • Medication 2:
    Dosage:     
    What for:   

  • Medication 3:
    Dosage:     
    What for:   

  • Do you have any allergies?*

  • Allergy 1:*
    Reaction:  *     

  • Allergy 2:
    Reaction:       

  • Allergy 3:
    Reaction:       

  • Health Questionnaire

    Please answer the following questions with ‘Yes’ or ‘No’. If you answer 'Yes' to any question, use the space to provide more information.
  • Have you ever had a seizure?*
  • Do you have any history of heart disease, defect or condition, whether treated or not?*
  • Do you have any history of heart disease in your family?*
  • Have you ever had a stroke?*
  • Have you or do you suffer from high blood pressure or hypertension?*
  • Have you ever had any liver or kidney problems or treatment?*
  • Have you ever been treated for a mental or psychiatric disorder?*
  • Do you have any history of heat, cold or high altitude injury?*
  • Have you been hospitalised, taken to the Emergency Room, or had an operation in the past 3 years?*
  • Do you have any neck / back / shoulder / knee / ankle or other orthopaedic problem?*
  • Do you require a medical device such as hearing aid, prosthetic device, pacemaker, etc?*
  • Are you currently pregnant or have you given birth in the last 12 months?*
  • Have you ever had or do you have chest pain or tightness?*
  • Have you ever had or do you have Diabetes, Epilepsy or Asthma?*

  • Fitness Evaluation

    If you have no experience please write “N/A.”

  • Race Distances: Please give details of events over 10km you have completed in the last 3 years and approximate finishing times

  • Current Training: Please give details of the average distance covered per week as part of your current training plan / routine.

  • Should be Empty: