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Pre-Activity Health Questionnaire 2025

The following health questionnaire is to be completed by the participant prior to receiving guidance, tuition or advice from SupSkiFit.

We reserve the right to refuse entry onto, or into, the water should any participant's health or ability to undertake water activities lead them to being unsafe or put other safety at risk.

Participant Details

Birthday
Day
Month
Year

Emergency Contact Details (Next of Kin)

Pre-Exercise Health Questions

Are you able to understand a safety brief in English?
Yes
No
Are you able to receive and understand instruction throughout the session?
Yes
No
Have you recently had an operation, chronic illness or injury
Yes
No
Do you have pain / limited movement that could prevent you from kneeling or standing on the board whilst paddling?
Yes
No
Are you currently taking any prescribed medication
Yes
No
Do you have any history of respiratory problems, chest tightness or pain?
Yes
No
Do you suffer from headaches, fainting or dizziness?
Yes
No
Do you have diabetes?
Yes
No
Do you have epilepsy?
Yes
No
Are you or could you be pregnant
Yes
No
N/A
Do you suffer from the effects of cold weather or water?
Yes
No

Participant Declaration

I confirm I am not taking part in any activity against my doctors advice

I agree to be bound by SupSkiFit safety rules throughout the session

I agree to wear all safety equipment provided whilst on the water

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Date
Day
Month
Year

SupSkiFit

Anglesey

catherine@supskifit.com

07969544988

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