Ride for Life 2022 - participant medical form - 1 Day Challenge

About you

Medical details

Have you ever suffered from the following:

• Heart problems

• High/Low blood pressure

• Asthma, Bronchitis or severe shortness of breath

• Tendon, ligament or cartilage damage

• Vertigo

• Infectious Disease

• Eczema or skin problems

• Diabetes

• Epilepsy

• Head Injuries

• Cancer

• Fractures or broken bones

• Back problems

• Migraine or severe headaches

Tick to confirm*

Tick to confirm*


Your information is held securely with all reasonable precautions used to protect it. If you are an EACH donor or supporter, your data may also be used for profiling to help us provide the best service possible. We will only allow your information to be used by suppliers working on our behalf and will only share it elsewhere if required to do so by law. This information will be shared with Chapeau Events, the event logistics company running Ride for Life on behalf of EACH. For full details, please see our privacy policy.  or email  supportercare@each.org.uk

Shopping Cart
Scroll to Top