Tropical Rainforest Ecology Option

Session 2017–2018

Information for Tropical Rainforest Ecology Option

provide all of the personal and insurance details as requested
complete the Health and Fitness Questionnaire

Personal Details

Any information supplied is protected by the Data Protection Acts and will remain confidential to the University of Glasgow.

* Compulsory, must be filled in.

† Please note that your NAME(S) must be exactly as shown on your passport.

Student ID Number	*
Surname †	*
Forename(s) †	*
Mobile Phone Number
Home Email Address

Name, Address of General Practitioner
Telephone Number

Name, Address of Next of Kin
Relationship	Other
Telephone Number
If your travel insurance is not supplied by the University of Glasgow, please complete the fields below.
Name of Travel Insurance Company

Travel Insurance Policy No.
Travel Insurance Telephone No.
Master Policy Reference (optional)

Health & Fitness Questionnaire

	No	Yes
1. Are you physically fit?

2. Do you suffer from any allergies? If so, to what?


3. Are you currently taking any medication (other than the contraceptive pill)?

4. Are you currently receiving medical care or have you consulted a doctor in the last year for anything other than a trivial infection or minor injury?

5. Do you suffer from any condition that would prevent your full participation in this field course, including participation in water-based activities? ¹

6. Do you suffer from any condition that might require medical intervention during this field course?

1 Relevant conditions include, for example, severe asthma or any other chest or lung complaint; previous chest or heart surgery; high blood pressure; fainting, blackouts or recurrent dizziness; epilepsy or fits; diabetes; regular ear, nose or sinus problems; or any other condition that might impair your capacity for physical activity on land and in water.

(If you have answered ‘YES’ to any of questions 2 – 6, you may be contacted by the field course organisers for clarification.)