Sea Trek® Participant Record and Liability Release Form
Name: ………………………………………………………………………………..........................
(print full name)
Address: ……………………………………………………………………………………….………..
(print complete address)
…………..……………………………………… …………. Post code: ……………………
Phone Number: ……………………………………….
Date of Birth: …..…/……../…….. Age ………………..
(Age limit: You must be over 8 years old to take part)
Emergency contact (name)………………..……………. Relationship…...…………………
Phone Number: ………………………………….
Please read this carefully – it contains important safety information.
Your health
Sea Trek at Manchester SEA LIFE ("Sea Trek") is an exciting activity but can be physically demanding. You must ensure that
you are medically fit and well enough to take part.
We cannot give you advice about your personal needs but we have set out some questions below to help you decide whether you
are fit to participate. This is not an exhaustive list but if you answer "Yes" to any of the questions, or
if you are unsure about an answer, you cannot participate until you have sought advice from
your doctor and they have countersigned and stamped this medical questionnaire.
Questions
1. Are you more than 3 months pregnant?
2. Do you have a history of heart attacks or heart disease, heart surgery or
strokes?
3. Do you have asthma or wheezing with breathing or exercise?
4. Are you currently suffering from a cold, congestion, sinusitis or bronchitis?
5. Have you had a collapsed lung (Pneumothorax), lung disease or history of
chest surgery?
6. Do you have a history of seizures, blackouts or fainting, convulsions or
epilepsy or take medication to prevent them?
7. Have you ever had a diving accident or decompression sickness?
8. Do you have a history of high blood pressure, angina or take medicine to
control blood pressure?
9. Do you suffer from or have a history of bleeding or other blood disorders?
10. Do you suffer from or have a history of any ear or sinus surgery, ear disease or
problems with balance?
11. Do you have a history of fear of closed or open spaces or panic attacks?
Yes/No
12. Do you have a history of Diabetes?
13. Are you currently taking medication that carries any warning about any
impairment of your physical or mental abilities?
14. Do you have a history or back, arm, or leg problems following an injury,
fracture or surgery?
15. Do you have a history of respiratory problems, severe attacks of hay fever or
allergies?
16. Do you have problems equalising (popping) ears with airplane or mountain
travel?
You must not take part if you are under the influence of drugs / alcohol or have any open cuts or abrasions. You must also have
a shower on exiting the water.
Disclaimer and declarations
By signing below, I declare that:
1.
2.
3.
4.
5.
I will abide by the rules, procedures and instructions in place for the Sea Trek experience.
I will listen carefully to and follow any instructions given by the Sea Trek staff.
I will not behave in a way that threatens either my safety or the safety of others.
I will not deliberately harm or injure any sea life during the Sea Trek experience.
I understand that I will not be allowed to take part or will not be allowed to continue in the Sea Trek if I do not follow
the rules at points 1 to 4 above.
6. I am medically fit and well enough to take part in the Sea Trek experience and that, in any event, I understand that I
participate in Sea Trek at my own risk.
7. I am unaware of any health or other condition which may affect my ability to safely take part in Sea Trek.
I also agree that Merlin Entertainments (Sea Life) Limited may use any photographs or video of me from today’s Sea
Trek in any of its marketing and promotions at any time in the future, including but not limited to:
o
o
o
in printed leaflets, flyers, catalogues, brochures, adverts in magazines/newspapers;
online through SEA LIFE's website and also through related blogs, Twitter, Facebook, Vimeo, YouTube;
and
in any editorial features about SEA LIFE either online, on tv or in printed publications.
We will never include your name or personal contact details in any of the above.
I also agree that I will not bring a claim against Merlin Entertainments (Sea Life) Limited, Sub Sea Systems, Inc., or seek to
hold the company liable for any loss, damage, costs, expenses, claim or action which may arise as a consequence of my
actions, behaviour or participation in the Sea Trek event.
This does not exclude any liability of Merlin Entertainments (Sea Life) Limited for death or personal injury as a result of its
negligence.
Participant name: _________________________________
Participant signature: ______________________________
Date: ___________
For under 16s, Parent/Guardian Signature: ____________________
Date: ___________