18-59 Yrs Licence Application 2021

1. APPLYING FOR YOUR LICENCE: Once you have completed all the required elements, you must submit your form and all accompanying paperwork to OCRDA using the SUBMIT button at the bottom of this form.

2. DECLARATION OF MEDICAL FITNESS TO RACE: Licensed competitors are required to complete the medical declaration (below) on an annual basis.

After you have been issued with a licence, it is important to let us know if your level of fitness has declined during the season, either through accident, injury or illness. It is imperative that you are fully fit before participating. PLEASE THINK CAREFULLY BEFORE PARTICIPATION.

3. Should you be involved in an accident during an event that requires medical assistance, your licence may be withdrawn pending a Medical Professional's note confirming your fitness to race.

4. POWERBOAT/JET SKI RACE NUMBER, Log Book / Registration Form: Please also complete the required information on the Log Book/Registration Form with the race number you would like to apply for, which, if available, will be confirmed with you. A link to the Log Book/Registration form is on the Thank You/submission confirmation page

Part A - Competitor Details

Type of Licence Required *

Age at Completion

Your Name *

First Name Last Name

Your Mobile Number *

07*** 123456

Your Payment: *

Please select

PAID? HOW?

Date of Birth *

Date

Are you Male/Female

Your Email *

example@example.com

Previous Licence No:

If you know it

*Licence No*.

Address *

Street Address

Street Address Line 2

Town

Postcode

If this is a new Licence Application, please attach a "Passport style" clear Head and Shoulder photo of yourself. If you are renewing your licence and your previous photo is still a good resemblance of you, there is no need to send any photo.

Browse Photos

Upload your photo here

OCRDA SELF DECLARATION MEDICAL FORM

for COMPETITORS AGED 18-60 YEARS

PLEASE NOTE: Competitors under 18 or over 60 years of age at time of application MUST complete a different application form AND have a full Medical.

1. The purpose of this form is to obtain a factual report of your state of health and medical history and to indicate your fitness to participate in the Event. Should you need to complete a full Medical due to age or existing medical conditions, please request the Medical Declaration and Examination form from OCRDA or download from the forms section of the website www.ocrda.com

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 and you may be asked to submit to a formal medical examination.

Any assessment may initially be in the form of a telephone call enquiry WHO may only need to endorse this form on your behalf, along with a written confirmation of your statements to the Assessor. It is likely a fee will be charged for this service.

Additionally, the Medical Assessor may require a statement from your GP and/or to see you for an examination (again, a fee may be payable). Should you be passed as fit to race, you will need to obtain from them a completed Certificate of Fitness to Race with an expiry date, OR a statement that further medical assessment is NOT required.

You should submit a copy of the Certificate of Fitness to Race as well as this form as part of your Licence Application. Please ensure you retain the original of the Certificate of Fitness to Race, as you may need to provide further copies for future declarations.

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

5. 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.

6. OCRDA reserve the right to refuse an application or suspend a licence if they feel the individual is unfit to race for whatever reason.

Part B - Medical History *

Yes

No

Have you suffered any dislocations within the last 12 months?

Have you ever been treated for a fractured limb?

Do you have any abnormality or restriction of power or range of movement of any arm or leg or of the cervical (neck) spine?

Do you have a history of any back and/or neck problems?

Have you had a coronary thrombosis (heart attack) or have undergone heart surgery?

Are you liable to epileptic seizures, fits, dizziness (vertigo), fainting attacks or blackouts of any duration?

Do you suffer problems with heart rhythm, or have a disease of the heart or arteries?

Do you have abnormal blood pressure that is not well controlled with drugs?

Do you have diabetes?

Have you had a stroke, or unexplained loss of consciousness?

Have you had a head injury associated with unconsciousness or concussion which required a stay in hospital for observation or investigation?

Do you suffer from Parkinson's disease or multiple sclerosis?

Do you suffer from claustrophobia?

Are you being treated for psychological or nervous problems?

Have you had an alcohol or drug dependency problems within the last 5 years?

Do you have profound deafness or any other impairment which affects your ability to communicate clearly by intercom/radio/telephone?

Have you suffered any disease of or injury or operation to either eye?

Do you have any problems with the sight in either of your eyes?

When racing, do you wear glasses?

When racing, do you wear contact lenses?

Do you suffer from double or tunnel vision?

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?

Do you smoke, have a high cholesterol level or family history of heart problems?

If you have entered YES to any of the above questions, you MUST please provide supporting information below.

If you have not entered YES, please enter N/A in the box below.

*

Supporting Information for any YES responses to medical declaration

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 and agree to submit to a medical examination if requested.

I also confirm that I carry sufficient personal accident cover for my needs and certify that this is the case.

Signature

Date

2021 OCRDA Licence Application (Ages 18 to 59)