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  • ENROLLMENT AND CONFIDENTIAL MEDICAL HISTORY RECORD

    OUTWARD BOUND HONG KONG (OBHK)
  • Course Code: 3CTC120

    Course Date: 2-4 May

  • General Information

  • - OBHK courses help participants discover and develop their potential to care for themselves, others and the world around them through challenging experiences in unfamiliar settings. These activities have varying elements and degrees of risk. Due to the variable conditions and unpredictable nature of the outdoors the risk can never be reduced to none. Risks are managed with a supportive approach, defined expectations, planning, experience and supervision. It is important that participants follow rules and instructions.

    - OBHK operates physically demanding wilderness courses in all types of weather. Courses may include swimming, running, climbing, hiking, kayaking and sailing expeditions during the summer and winter. Participants sleep in tents or under improvised shelters. They do their own supervised cooking and carry heavy backpacks. Many programmes include structured and supervised ‘Solo’ experiences of up to 24 hours. Water activities may include swimming, kayaking and sailing. OBHK provides suitable equipment and ample meals but may not be able to meet certain special dietary requirements. Students are expected to refrain from the use of non-prescription drugs, tobacco, alcohol and other stimulants or depressants during the programme.

    - Each participant is responsible for any medical expenses, including medical evacuation, and should be covered by their own personal medical and accident insurance.

    - If you arrive at the start of a course with a pre-existing condition or injury which is not indicated on your medical form, and you are subsequently forced to leave the course because of this condition, you will be charged an evacuation fee and will not receive a refund of course fees.

    - To be completed by the applicant, parent or guardian. A parent/guardian must sign this form if the applicant is under 18 years of age. Your enrolment is confirmed only when OBHK receive all completed forms. This medical form helps us to best manage the risks associated with our courses. If, after reviewing your medical form, OBHK concludes you should not participate in the course at this time, we will refund all course fees made to OBHK. We cannot cover or refund costs of medical examinations or other expenses you incur preparing for a course.

    - OBHK takes reasonable precautions to prevent the loss, misappropriation, unauthorised access or destruction of your data. OBHK also takes reasonable steps to ensure that all personal data held by it is accurate, complete, correct and reliable for the intended use. Your personal data will be retained by OBHK according to its policy on retention of data and records.

  • Personal Particulars


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  • Emergency Contact

    Person to be notified in case of illness or injury
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  • Part A - Medical History

    Please answer Questions 1 -33
  • General Information

    - We urge you to be completely transparent in providing OBHK with information requested. Many participants over the years who have had a variety of medical/psychological difficulties have attended and successfully completed courses, but we must be aware of any such conditions for your safety. Failure to disclose such information could result in harm to you and your fellow participants.

    - Note that OBHK will reduce strenuous activities and the physicality of its courses when the AQHI is “VERY HIGH”, but it will not discontinue any programming until the AQHI exceeds “Serious”.

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  •   Symptoms when
    AQHI is high (AQHI = 7)
    AQHI is very high (AQHI 8-10)
    AQHI is serious (AQHI above 10)
  •   Symptoms when
    AQHI is high (AQHI = 7)
    AQHI is very high (AQHI 8-10)
    AQHI is serious (AQHI above 10)

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    Cancel of
  • Authorise Medication to be administered by OBHK Staff

    All OBHK staff carry the below medication and will administer medications according to clearly stated protocols. Please indicate if you consent to these being administered.
  • Consent for Medication Administration of Participants under age of 18

    • To ensure the safety of the participant, the following procedures regarding medication brought to and administered by OBHK staff have been put in place. (Medication refers to routinely prescribed medicines administered orally (tablets or liquid) or injected.
    • The below table must be completed by the parent/guardian of a participant under 18 years of age. OBHK does not assume responsibility for any reactions that may occur following administration of medication sent from home, nor can there be any responsibility assumed if you do not bring sufficient medication.
  •   To Be Completed by Parents
    Medication:
    Dose:
    Time:
    Dates:
    Reason:
  •   To Be Completed by Parents
    Medication:
    Dose:
    Time:
    Dates:
    Reason:
  •   To Be Completed by Parents
    Medication:
    Dose:
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  • Enrollment Information


  • Part B - Safety Statement

  • At OBHK we realise that there are inherent risks in the activities we undertake and in the environments in which we undertake them; rest assured that we continually assess and manage them. The learning process often involves deliberately encouraging participants to take part in activities containing unfamiliar risks to them. Participants must also understand that their care, safety and well-being are our greatest concern.

    We will not as a result restrict activities to remove such risks however the principle is to prepare participants to deal appropriately with any risks involved. We aim to achieve continual improvement in our health and safety performance by adopting the following:

    • Achieved external accreditation (AEE)

    • Implemented a risk management system

    • Pursuing internationally recognised best practices within our operations

    • Implemented an international inspection and ongoing auditing programme

    • Managing staff competence to ensure they complete judgment training so all activities are taught in a safe manner

    • Maintain written safety standards that govern all aspects of our operations

    • Maintain an external Safety Committee that monitors all safety practices within our operations

    • Educating participants on safety and personal hygiene

    • Encouraging a ‘what if’ attitude towards each and every experience

    • Maintain ongoing safety and specific skills training

    • All field staff must maintain current life-saving and first aid certification

    • Each and every incident is stringently reported and followed up

  • Part C - Voluntary Assumption of Risk

  • By signing this document,

    1. I acknowledge my voluntary assumption of the risk associated with participating on an Outward Bound Course.
    2. I am aware that my participation on any trip or course with The Outward Bound Trust of Hong Kong Limited (“Outward Bound Hong Kong”) involves exposure to risks, dangers and hazards which may be greater or different than those I normally encounter daily.
    3. Such risks, dangers and hazards include but are not limited to:
      - inadequate physical fitness or endurance;
      - travel and living in the wilderness (through the sea & land);
      - natural hazards, including but not limited to, hill fire, landslip, rockfall and flooding
      - the use and operation of vehicles, vessels and/or equipment;
      - changing weather and varying environmental and/or wilderness conditions;
      - encounters with wild animals, insects and/or plants;
      - behaviour, actions or omissions on the part of fellow participants and/or staff on course
      - the first aid and/or emergency care available
    4. I am aware that I may be exposed to risks, dangers and hazards other than those listed above.
    5. I acknowledge that I have had access to information about the course made available through briefings, documentation and website
    6. I freely accept and fully assume all and any such risks, dangers and hazards, inherent and otherwise and whether or not described above and the possibility of personal injury, death, property damage, or loss resulting from such risks, dangers and hazards, arising out of incidental to, or in any way connected with my enrolment or participation on the course.
    7. I have to the best of my knowledge truthfully and honestly completed the Outward Bound Hong Kong Confidential Medical History Form and that Outward Bound Hong Kong will rely upon the medical information disclosed therein;
    8. I am aware that Outward Bound Hong Kong uses Kowloon Motor Bus Company (KMB) busses and private water taxis to transport students from our basecamp to campsites and trailheads in our course area.
    9. I agree that the laws of Hong Kong govern this contract and that any legal concerns will be handled in the competent and fair courts in Hong Kong.
  • Part D - Outward Bound Hong Kong Policy

  • Duty of Care

    OBHK shall provide duty of care for participants from course start to end. Specific start and end times along with locations shall be made available during the enrolment process. Transport to and from the course start and end points is entirely the responsibility of the school, agency, company, parents or guardians. Reasonable and appropriate measures must be taken by the school, agency, company, parents or guardians for any minor to be transported to or from course start and end to their homes or desired destination.

    Leaving from the Course

    Only in exceptional circumstances will it be possible for a participant to leave at any part of the course to attend other commitments such as examinations. Consideration will only be given if written advice is given before the course begins.

    Cancellation or Absence

    Under the Contract Course Agreement, OBHK does not provide a refund for unused place(s) under any circumstances.

  • Part E - Declaration

    1. I, the undersigned, declare that the information provided is true and complete. I agree that my/the applicant’s personal data
      may be used by OBHK and its staff for administration, programming and emergencies.
    2. I (and the applicant) have read and understood the details outlined in this document and agree to abide by the rules for
      taking part in the OBHK course, in particular, to abstain from alcohol, tobacco and illegal substances, as well as to
      participate fully and co-operatively with the staff and others. I/The applicant understand(s) and accept(s) that if the rules
      or instructions are not observed, I/the applicant may be dismissed from the course.
    3. I (and the applicant) understand that the course is vigorous and demanding. To the best of my knowledge, there are no
      medical or other reasons why I/the applicant should not take part in this course. I/The applicant am/is in normal health with no undeclared pre-existing medical or psychological conditions, or allergies.
    4. I further agree that should I/or my child require medical treatment, I consent for myself/him/her to receive whatever
      treatment deemed necessary and determined by a registered doctor. I agree to pay for any/all treatment required for doctor and/or hospital consultations.
    5. I agree to allow Outward Bound Hong Kong to use any and all images and/or testimonials taken of or provided by me
      during the course for any and all marketing purposes.
    6. I have read and understood this release and indemnity agreement prior to signing it. I am aware that by signing below, I am
      affecting my legal rights and liabilities and the legal rights and liabilities of my heirs, next of kin, executors, administrators and
      assigns in relation to OBHK. I undertake to abide by the safety directions given by the staff of OBHK during the course.
  • Part F - Group Personal Accident Insurance Scheme (With Accidental Medical Expenses)(OPTIONAL)

  • OBHK carries third party liability insurance. In the event of an accident or illness during the course requiring external treatment, government hospitals or clinics will be utilised, unless in the case of minor illness or accidents whereby private clinics may be used. Participants will be required to pay all private clinical costs. Participants can arrange their own personal insurance or join through the scheme offered by Zurich Insurance Company Limited to participants aged between 8 and 65 years. The scheme carries a maximum of HK$500,000 in the event of accidental death or permanent disablement during any OBHK course, and HK$20,000 for accidental medical expenses.

    For full details, please see Insurance Details

    Group Personal Accident Insurance Costs:

    Duration Without Accidental Medical Expenses (HKD) Duration With Accidental Medical Expenses (HKD)
    1-7 Days 90 1-7 Days 130
    8-14 Days 160 8-14 Days 230
    15-21 Days 240 15-21 Days 340

    Reminder:

    - Please note that no insurance will be effective unless payment is made before course commencement.

    - The premium is non-refundable under any circumstances.

    - Participants who do not own an HKID card requiring treatment at hospitals must pay a deposit prior to receiving treatment. This process requires the use of a credit card which OBHK will not supply.

    Please contact info@outwardbound.org.hk for more information regarding any of the above.

  • Consent

  • - Consent is hereby given for the applicant to attend an OBHK course and permission is given for any emergency anaesthesia, operation, hospitalisation, above medication and/ or other treatment which may be defined necessary.

    - I have read the description of OBHK courses within this medical record and I understand that the programme can involve physically and mentally strenuous activities in a remote wilderness area potentially far from urban facilities.

    - If I have indicated that I require regular medication I shall bring it with me. If I fail to do so I understand that I may not be able to begin the course.

    The information provided above is a complete and accurate statement of the physical and psychological factors which may affect my participation on an OBHK course, I realise that failure to disclose such information could result in serious harm to me and my fellow participants and I agree to indemnify and waive OBHK of all liability if all relevant information is not disclosed.

  • Digital Signature Disclaimer

  • Electronic Transactions Ordinance (Cap. 533) gives electronic records and digital signatures the same legal status as their paper-based counterparts. By signing the box below, I affirm that the information provided above is a complete and accurate statement of the physical and psychological factors which may affect my participation on an OBHK course. I realise that failure to disclose such information could result in serious harm to me and my fellow participants and I agree to indemnify and waive OBHK of all liability if all relevant information is not disclosed

  • Signature

    - Applicant (18 years of age or above); OR

    - Parent / legal guardian (applicant under 18 years of age)

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