Who will. fall for us? You decide...

Similar documents
10,000 ft Freefall Parachute Jump!

Skydive Information Pack

The PACT for Autism Skydive Fund Raising Scheme (Charity No )

Occupational diver medical assessment questionnaire

REEFTRIP.com. Medical Questionnaire Dive Medical Recreational AS Section Abbott Street, Cairns T: E:

New Member Joining Pack SAA 1063

Greenslopes Family Practice

MEDICAL ASSESSMENT FORM 2018

Medical declaration for divers

VIKING DIVING SERVICES, Inc Application for employment

APPLICATION FOR A RIDERS QUALIFICATION CERTIFICATE (RQC) For the 2017 / 2018 POINT-TO-POINT SEASON

ur mission is to encourage pride <5t excellence in a community of learning. LUMSDEN HIGH SCHOOL May 15 th, 2018

Solo Swimmer Application

TOURNAMENT RULES. - Misconduct towards referee - Infringement of sportsmanship - If suspected of being under the influence of drugs or alcohol

Senior Master Tam Fook Chee presents the: Under 18 years old. Sunday 22nd November am Venue: Burwood PCYC 7 Deane St Burwood NSW

APPLICATION FOR A RIDERS QUALIFICATION CERTIFICATE (RQC) For the 2015 / 2016 POINT-TO-POINT SEASON

Application for ADULT AND JUNIOR Competition Licence If you made payment online, please enter your address used here:

BANGER / ROOKIE ROD LICENCE 2019

The Salford Charity Dragon Boat Festival 2015

The Bradford Lord Mayor's Appeal Dragon Boat Festival 2015

Dear Veterans, WHAT is the program about?

BRITISH NATIONAL OPEN PARACHUTE CHAMPIONSHIPS 2017 IN SPEED SKYDIVING

PRE TRAINING QUESTIONNAIRE

Surf Life Saving Australia Policy

DRIVING (TRACK WORK / PREPARATION)

CINQUE PORTS SAILING Ltd tel:

Royal Cinque Ports Yacht Club Sailing School Tel: +44 (0)

Truro City Swimming Club (Affiliated to the Amateur Swimming Association) Membership Application

2018 FIM International Licence Application

NHRPA DRIVERS RACING CONTRACT 2019

BUTLER GOLDEN TORNADO HOCKEY ASSOCIATION TRYOUT INFORMATION

DESCRIBE ANY MEDICAL PROBLEMS OR INJURIES

Medical Section. Fax : (toll-free) or

2018 Skydiver s Information Manual Summary of Changes

DAN EUROPE PROCEDURES FOR THE MANAGEMENT OF DIVING ACCIDENTS AND PAYMENT OF CLAIMS CONCERNING MEMBERS OF DAN EUROPE

Application for ADULT AND JUNIOR Competition Licence 2019 PLEASE RETURN YOUR OLD LICENCE WITH THIS APPLICATION

Reviewing Hyperbaric Oxygen Services: Consultation Guide

Taekwondo Chungdokwan

SWIM Across the Sound Marathon

SAFETY PLAN TEMPLATE

HotCheer AllStars. Items to turn in on Commitment Day. HotCheer Commitment Form. HotCheer Registration Form. Athlete Birth Certificate

Patient Information. Physician Information

Fairways Health Club Welcome Pack

COLD ASH BOYS & GIRLS FOOTBALL CLUB Founded PLAYER MEMBERSHIP FOR 2015/16 SEASON

Youth Diving: Responsibility and Risks Flipchart. Welcome

Guidance on the Medical Assessment of Divers

COLD ASH BOYS & GIRLS FOOTBALL CLUB Founded PLAYER MEMBERSHIP FOR 2018/19 SEASON

Veterans High School

Romsey District. 1 Course Sat 9 May 15 13:30-15:00 or 15:30-17:00 19:30-21:00. 2 Course

Junior Scholarship Application Form (Applicants must be aged between years old)

MEDICAL DEPARTMENT PASSENGER INFORMATION PHYSICIAN INFORMATION

Mowsbury Golf Club Junior Application Form

Renewing Athlete Registration 2018

LIVERPOOL CATHEDRAL CHARITY ABSEIL

PERSONAL INJURY PATIENT HISTORY

2012 AUSTRALIAN OLYMPIC TEAM DIVING AUSTRALIA NOMINATION CRITERIA

Snorkeling BSA Certification

CINQUE PORTS SAILING Ltd Tel:

Wu Chi School of Arts

ST ASAPH SPRING FAIR 2018 ABSEIL REGISTRATION FORM. Saturday May 26 th 2018

Withdrawal from an Aegon General Investment Account (GIA) into an existing Aegon ISA

Pleasant Prairie Patriots House Hockey

Health Hazards Matrix for common roles in RMG

SUTTON COLDFIELD CRICKET CLUB JUNIOR MEMBERSHIP APPLICATION

Discovery Bay Marine Laboratory

Information about oxygen

Health & Safety Plan `

Chairman, Malta Tourism Authority MALTA TRAVEL AND TOURISM SERVICES ACT. (CAP. 409) Recreational Diving Services Regulations, 2012

Application Form Course applying for: Applications will not be accepted without photographs Dance Applicants, PTC and MTC Applicants,

OPTIMA HEALTH MEDICAL FITNESS ASSESSMENT FOR TRAIN DRIVERS / TRAIN DRIVER MANAGERS PROCEDURE

Competition Rules Speed Skydiving

APPLICATION FORM FOR DAN GRADING

1.1 All abseil bookings are sold subject to these terms and conditions.

Proudly Sponsored by O'Donnell Legal and the Balmoral Cycling Club.

UOG Marine Laboratory Scientific Snorkeling Policy Guide

Withdrawal from an Aegon General Investment Account (GIA) into an Aegon Junior ISA (JISA)

SOUTHEAST TEXAS MARCHING PERCUSSION CAMP

Werewolves of London Special Ice Hockey Club Player Information and Parent/Carer Publicity Consent Form

2017 FIM International Licence Application

Hospital Admissions in the Northern Territory

Publications order form

TITLE I - GENERAL PROVISIONS... 2 TITLE II - MEDICAL EXAMINATIONS AND CONDITIONS FOR PARTICIPATION IN THE COMPETITION... 3

DENVILLE RECREATION 2014 SKI & SNOWBOARD PROGRAM

Bayou Wing Chun Waiver APPLICATION FORM

Please remember that the only prerequisites are that your sailor can swim and comes to camp with a fun attitude.

Do you wish to apply for a shotgun certificate which will expire at the same time as your firearm certificate? Yes No

OXYGEN THERAPY AND QUALITY OF LIFE Oxygen Therapy and Quality of Life

Female. Gender: Male. padi.comor mailing the Discover Scuba Diving Registration Formto your PADI Office. Discover Scuba Diving Registration Form

DIVING AND HYPERBARIC MEDICINE Application for transitional award of diploma or recognition of prior experience

ALL FIELDS ARE REQUIRED

Hyperbaric Oxygen Therapy

BANDAGED BEAR APPEAL SCHOOL RESOURCE KIT

Aegon General Investment Account joint holders form

UKA Medical Advice. Hot Weather

New Home Oxygen Contract

Participants Name Age (as of 7/31/15): Weight: PROGRAM Tackle Football Cheer Flag Football

APPENDIX 1 PER THE AMERICAN ACADEMY OF UNDERWATER SCIENCES STANARDS DIVING MEDICAL EXAM OVERVIEW FOR THE EXAMINING PHYSICIAN

OXYGEN FOR ADULTS IN ACUTE CARE

J u n i o r Te n n i s C a m p s

Terms and Conditions. 1. Abseiling Experience:

Transcription:

Charity reg no. 207994 (England & Wales), SCO38731 (Scotland) M330 Who will fall for us? You decide... Marie Curie Cancer Care provides high quality nursing, totally free, to give people with terminal cancer and other illnesses the choice of dying at home, supported by their families.

Who will fall for us? You decide... Can you think of someone you d like to see falling from a plane from 10,000 feet at 120mph? Whether this is your teacher, your boss or one of your peers, Marie Curie Cancer Care has a fundraising event to make this possible. Who Will Fall For Us? You Decide is a simple but fun way to raise vital funds for Marie Curie Cancer Care that your whole organisation can enjoy. How it works Senior members of an organisation, for example teachers or managers, put themselves forward as candidates to complete a tandem parachute jump (where you re attached to an instructor) for Marie Curie Cancer Care. You can have as many candidates as you like, but the minimum is two. There are restrictions on who can do a parachute jump, which are explained below. Members of your organisation, for example pupils or staff, then vote for the candidate they d most like to see falling from a plane. Each vote costs 1 - a pound a push - and you can vote as many times as you like (however schools may want to restrict this to one vote per pupil). The fundraising The sponsorship you raise will help us continue to provide care and support to terminally ill patients and their families, in their own homes completely free of charge. Just 20 helps provide one hour of nursing care, so every penny you raise really will make a difference. In order to complete a tandem parachute jump, you need to raise a minimum of 400. So before deciding to take part in Who Will Fall For Us? You Decide you will need to consider how long it will take to raise this amount given the size of your organisation. Some of the fundraising can be used to cover the jump costs including the registration fee of 50 and the jump itself of 185, with the minimum remainder of 165 coming to Marie Curie Cancer Care. The Table below shows the costs of completing a tandem charity jump, when the costs have to be paid and to whom. Cost What for? Where to? Paid when? 50 Deposit to secure your jump London Parachute School Upon booking your jump 185 Cost of your jump The Drop Zone where you will jump On the day of your jump 165+ Marie Curie Cancer Care Marie Curie Cancer Care One week prior to your jump

The restrictions Candidates must weigh less than 15 stone, as the parachute itself can only hold a certain level of weight taking into account you will be jumping strapped to a professional. Anyone over the age of 40 will need a Declaration of Fitness signed/stamped by their GP a declaration is provided in this pack. If you have: previous fractures; back strain; arthritis and severe joint sprains; chronic bronchitis; asthma; rheumatic fever; pneumothorax; liver or kidney disease; anaemia; thyroid, adrenal or other glandular disorder; chronic ear or sinus disease or any condition which requires the regular use of drugs, then you will also require a signed/stamped Declaration of Fitness by your GP. The following conditions will prevent you from completing a parachute jump: epilepsy; fits; severe head injury; recurrent blackouts or giddiness; disease of the brain or nervous system; high blood pressure; heart or lung disease; recurrent weakness or dislocation of any limb; diabetes; mental illness; drug or alcohol addiction. If you have any concerns regarding these restrictions, then please contact our parachuting providers London Parachute School on: 0845 130 7194 and they will be happy to answer your queries. Getting organised Select your candidates, ensuring that they all meet the restrictions listed above. Launch Who Will Fall For Us? You Decide to your organisation, either through a school assembly, staff bulletin, intranet etc. Create and display voting posters: enclosed is a template you can print off and complete. Book your jump through London Parachute School online or download a paper registration form through our website /parachuting. At this stage you won t know who has won the vote and will be completing the tandem jump, so just put TBC in the fields that require their name and personal details. You can complete the address field by inserting the address of your organisation. Collect the monies/votes: this can be done at school registration or using voting boxes. At the end of the fundraising period (latest being one week before your jump), count up the votes for each candidate and determine the winner and notify London Parachute School of their name, address, email, gender, date of birth, height and weight. One week prior to the jump: Send a cheque for a minimum of 165, made payable to Marie Curie Cancer Care, for the amount raised Remember to keep aside 185 to cover the jump cost. Send a cheque along with a covering letter including details of the winning candidate and organisation, to: Parachuting Supporter Administration Team Marie Curie Cancer Care PO BOX 23897 14 Links Place Edinburgh EH6 9AB Take 185 to the Drop Zone on the day of your jump and complete the jump London Parachute School can video record the parachute jump for an additional fee. After the jump we will send out a thank you letter, confirmation of the amount raised and a certificate. If you have any queries regarding the above, please don t hesitate to contact Isla McLean, Events Development and Marketing Coordinator on 0131 561 3933 or email her at isla.mclean@mariecurie.org.uk

Vote for... INSERT PICTURE AND NAME OF CANDIDATE

BRITISH PARACHUTE ASSOCIATION LTD 5 Wharf Way, Glen Parva, Leicester, LE2 9TF Telephone: 0116 278 5271, Fax: 0116 247 7662, e-mail: skydive@bpa.org.uk www.bpa.org.uk STUDENT TANDEM PARACHUTIST DECLARATION OF FITNESS I hereby declare that I am physically fit. I do not, and have not, suffered from any of the following conditions, which I understand may lead to a dangerous situation with regard to myself or other persons during parachuting: Epilepsy, fits, severe head injury, recurrent blackouts or giddiness, disease of the brain or nervous system, high blood pressure, heart or lung disease, recurrent weakness or dislocation of any limb, diabetes, mental illness, drug or alcohol addiction. I further declare that in the event of contracting or suspecting any of the above conditions, or in the event of sickness absence over twenty consecutive days, incapacitating injury or confirmation of pregnancy, I will cease to parachute until I have obtained medical approval. I have read the notes overleaf. Name in CAPITALS Date of Birth Weight Signature Date BPA Number Height (May be issued on day of Course) Signature of Witness Name of Witness in CAPITALS (All parachutists require their Declaration Witnessed, for parachutists under 18 years of age, the Witness MUST be the parent or guardian) IF YOU CANNOT SIGN THE DECLARATION BECAUSE OF ANY OF THE ABOVE CONDITIONS, OR IF YOU ARE AGED 40 OR MORE, YOU MUST OBTAIN THE DOCTOR S CERTIFICATE OVERLEAF BEFORE PARACHUTING. THIS IS NOT NHS WORK AND YOUR DOCTOR MAY CHARGE YOU FOR THIS.

DOCTOR S CERTIFICATE I understand that the applicant wishes to make a student tandem parachute descent but is unable to sign the attached declaration/ is aged 40 or over*. I have read the notes overleaf. In my opinion the applicant is physically and mentally capable of parachuting as a student tandem and is medically safe to do so. * Delete as applicable Signature Date of signature Date of expiry (see Validity, over) (Doctor s stamp) Form 115(i) (Issue 7, June 2004) NOTES FOR PARACHUTISTS Student tandem parachutists do not have to be particularly fit but there are some medical conditions that can cause problems. As well as the conditions listed overleaf, the following may cause problems to parachutists. If you have ever suffered from any of them you must have your doctor s approval before parachuting: Previous fractures; back strain; arthritis and severe joint sprains; chronic bronchitis; asthma; rheumatic fever; pneumothorax; liver or kidney disease; anaemia; thyroid, adrenal or other glandular disorder; chronic ear or sinus disease; any condition which requires the regular use of drugs. Blindness is no barrier to tandem parachuting. However, if you do wear spectacles they should be securely attached while parachuting. Protective goggles should be worn. NOTES FOR DOCTORS Cardiorespiratory fitness is important. Student tandem parachutists make descents from unpressurised aircraft at heights of 5,500 to 15,000 feet above sea level without supplementary oxygen. At 15,500 feet there is a 40% reduction in available oxygen. A tachycardia of 120-160 bpm is common in experienced parachutists and 200 bpm is not unusual in novices. The tachycardia may be present at the same time as relative hypoxia. Ischaemic heart disease, uncontrolled hypertension and cerebrovascular disease are absolute contraindications. Candidates with traumatic tetraplegia may have reduced ventilatory capacity. The examining doctor should be satisfied that any impairment will not cause respiratory embarrassment at altitude. A history of autonomic dysreflexia should be excluded in candidates with spinal injuries above mid-dorsal level. Specialist advice should be sought in cases of doubt. Student tandem parachutists are strapped to an experienced instructor throughout the aircraft ride and parachute descent. The instructor and student share a common large parachute but only the instructor can open it or initiate any emergency procedures. Musculoskeletal fitness is not required and even paralysis or partial amputation of limbs is acceptable provided the instructor secures flaccid limbs before the jump. During the parachute deployment there is a brisk deceleration, usually about 4g but occasionally up to 15g.

Unstable spinal injuries or subluxation may be exacerbated by such deceleration. The landing impact typically involves a variable descent rate equivalent to jumping from a wall 0-4 feet high, with a horizontal speed of 0-15 mph. Occasionally the landing impact may be considerably greater than this. Pre-existing spinal problems, joint injuries and arthritis can be exacerbated but are far less likely to be aggravated by a tandem jump than by any other form of parachuting, due to the descent and landing being controlled by a very experienced instructor. There have been isolated reports of advanced osteoporosis in chronically immobile candidates being associated with spontaneous fractures in the course of an uneventful tandem parachute descent. Middle ear or sinus disease may cause problems due to the rapid changes in ambient air pressure. The rate of descent in freefall may exceed 10,000 ft/min and under an open canopy 1,000 ft/min. Neither blindness or deafness constitutes a barrier to student tandem parachuting, but the candidate must be capable of appreciating what is happening and of giving informed consent. Stable diabetes with no tendency to hypoglycaemia is acceptable. Epilepsy is not a contraindication provided that control is good and there have been no fits or changes in medication in the last two years. Most neurodegenerative disorders are acceptable unless respiratory impairment or marked postural hypotension are present. Normal mental development and a stable mental state are important. The candidate must be able to understand what he/she is about to do and be capable of giving fully informed consent. The candidate s behaviour must not pose a risk to the Tandem Instructor. Current neurosis requiring active treatment, history of psychosis, subnormality, pathological euphoria, drug addition and alcohol dependence all constitute a contraindication. A certifying doctor is not stating that a candidate will remain free of injury during parachuting, but that records, history or appropriate clinical examination have not suggested unacceptable medical risk factors. In cases of doubt, or where further information is required, the Medical Adviser to the British Parachute Association or the National Coach and Safety Officer will be pleased to help, and may be contacted at the address overleaf. VALIDITY The Parachutist s Declaration overleaf places the parachutist under a permanent obligation to cease parachuting until obtaining a doctor s approval if he/she develops any of the listed conditions. It is valid initially up to the age of 40, but should be renewed every two years between the ages of 40 and 49 and every year from the age of 50. Doctor s Certificates are valid as follows: If required under age 40 - As indicated by stability of medical condition (but not beyond age 40) Age 40-49 years - The longer of three years or until age 50 Age 50 years or over - three years providing that the examining doctor can specify a shorter period of validity if he/she feels it appropriate.