C-MASTERS cares about your health and wellbeing

Before your course can start, we request you to take a few minutes and provide relevant details on your medical condition for participating at the course. Simply fill in this form and send it by clicking on the submit button at the end of the form.

We will treat your data confidentially, see also our privacy policy.

Any reported illness or medical conditions need not necessarily prevent you from taking a full part in the course, but the Principal or instructor must be aware of any potential problem.

If you are in any doubt about your fitness or physical ability to take part in a course, then make sure to contact your Medical doctor for advice.

Thank you for your kind co-operation.

First name:

Last name:

My course will start on:

Do you have any dietary requirements ?

Yes

If YES, please provide details

Do you have a cold, sneezing, coughing or show symptoms of a fever ?

Yes

Do you receive medical treatment and/or use medicines ?

Yes

If YES, please specify which medicines and/or treatment

Do you suffer from sea sickness, epilepsy, dizziness, asthma, diabetes, heart condition or anything else you believe may affect you during your time with us ?

Yes

If YES, please provide details

Please provide your contacts in case of medical emergencies:

Contact person on shore (e.g. partner, family member, friend), including phone number

Name of Medical doctor , provide phone number:

I declare:

To the best of my knowledge, I am fit and able to participate in the course.

Submit