Participant's Name *

First Name

Last Name

I have read the above conditions and hereby agree *

Yes

Emergency Contact *

First Name

Last Name

Please read the following list and indicate if you have or have had any of the following conditions.

Heart Problems

Respiratory Problems/Asthma

Allergies that may need first aid

Diabetes

Epilepsy

Any other condition/s that we should be aware of

I hereby authorise the Company and/or professional staff to obtain such medical attention as may be deemed necessary, and I understand I am responsible for any associated costs. *

Yes

I agree to allow DRILL to use photographic and video material which may contain my image, this year and in the future, for the purpose for the content of the work, company marketing, publicity, promotion and sharing with our funding and industry partners. Please contact DRILL if you do not wish to be photographed to specify if being photographed from the back is acceptable. *

Yes

No