Booking Form & Health Questionnaire The form below covers participants for both Adventurous Journey and the Residential Project COVID-19 Protocol Read More...Disclaimer Notification Read More...POPI Policy & Compliance Read More... What is Your Relationship to ParticipantParentGuardianTeacherPrinciple Gender of ParticipantMaleFemale TPA LevelBronzeSilverGold I am attending the following programmesBoth Adventurous Journey and Residential ProjectOnly Adventurous JourneyOnly Residential Project Has your doctor ever said that you have a heart condition and that you should only do physical exercise activity recommended by a doctorYesNo Do you feel pain in your chest when you do physical activityYesNo In the past three months, have you experienced any unexplained chest painYesNo Are you on any medication for blood pressure or any other heart conditionYesNo Do you lose your balance due to dizziness or do you even lose consciousnessYesNo Do you have any bone or joint problem that could be made worse by a change in your physical activityYesNo How would you describe your current level of activity?Not ActiveFairly ActiveActiveHighly Active Have you been informed your blood cholesterol is high?YesNo Do you currently have any form of muscle, joint or back pain?YesNo Do you suffer or have you ever suffered from diabetesYesNo Do you suffer or have you ever suffered from asthma?YesNo Do you have any condition that may be worsened by physical exerciseYesNo I confirm I have completed this Health Questionnaire to the best of my knowledgeYesNo Submit Form NB: When you click SUBMIT FORM, Scroll to the top of this page to ensure you see the note 'Your Message was sent successfully' Get In Touch 0825704690 info@ubukwa.com 20 Tinderwood Loop uBukwa Hosts Rick Ross Vivamus element modo semper Aenean vulementum semper Aenean vulputate set tellus. Links About Us Causes Testimonial Events Contact Us Contact Us 0825704690 info@ubukwa.com 20 Tinderwood Loop © 2025 uBukwa Consulting
