The Fly Program Ltd.
Medical Form

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Retreats can involve trekking, fishing and mountain biking over extended periods of time. You will need a good level of fitness and good health. Suggested preparation: 45 minutes of aerobic exercise (eg: either cycling or jogging/walking) 3 to 5 times a week for 1 month prior to your trip. As you may often be hours from medical help other than our trained staff and first aid kits it is important that only able people participate on these trips. We require that all participants complete the following questions accurately. This information is important and has been invaluable in the past. We ask for your kind co-operation in these matters and invite you to email our team info@flyprogram.org.au should you have any queries. It is important that we are alerted to any special medical needs of our participants. Anything relevant in your medical history will go with your group leader and then be destroyed.
Fitness
(An idea of reasonable fitness is the ability to walk over rough ground with a daypack for 7 hours with only short stops)

IF THE ANSWER IS “YES” TO ANY OF THE FOLLOWING QUESTIONS, PLEASE SUPPLY FULL INFORMATION FURTHER DOWN THE FORM

1. Raised blood pressure?(Required)
2. Joint or Mobility problems in last 12mths?(Required)
3. Heart or circulatory disease?(Required)
4. Chest /lung disease?(Required)
5. Diabetes?(Required)
6. Epilepsy/neurological problem?(Required)
7. Digestive or bowel disorders?(Required)
8. Asthma?(Required)
9. Surgical operations in the last 12 months?(Required)
10. Mental Health conditions?(Required)
11. Any other problems?(Required)

EMERGENCY CONTACT DETAILS

We ask for your kind co-operation in these matters and invite you to email our team info@flyprogram.org.au should you have any queries. It is important that we are alerted to any special medical needs of our participants. Anything relevant in your medical history will go with your group leader and then be destroyed.
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Consent(Required)