Health Declaration Health Declaration Your Name* First Last Email* Do you have any of the following medical conditions?* Neurological conditions – including brain tumours, cerebral aneurysms, stroke Mental health conditions - including anxiety/panic attacks Limb and joint problems – including joint replacement Learning difficulties Kidney or bladder problems Heart conditions Hearing or vision impairment? Epilepsy Diabetes Cancer Blood disorder – including anaemia, haemorrhagic conditions Back/spine issues Allergies Abdominal/liver/bowel problems Are you pregnant? espiratory/Lung conditions - including asthma None of the above Please outline in further detail if you have any of the medical conditions outlined above.*Enter N/A if you have selected "None of the above"Have you ever been advised not to ride by a Health Professional?*YesNoPlease detail the reason below if you have ever been advised not to ride by a Health Professional.Please provide details if you have suffered other serious injuries, operations and illness that have required time in hospital or more than a week off riding.List the year and the injuries, operation and/or illness.Have you had any episodes of head injury and/or concussion that have required an absence from riding?YesNoIf yes, please list the approximate number of episodes.List the years the injuries occurred in.Have you had any episodes of head injury and/or concussion in the past two years?YesNoIf yes, please provide details.Declaration*I declare that all information provided in this health declaration form is true. If any of the circumstances change between the time I have submitted this health declaration form and the commencement of the ride, I will notify the change to Globetrotting immediately. YES