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🇻🇨 Saint Vincent And The Grenadines +1784 🇻🇪 Venezuela +58 🇻🇬 Virgin Islands, British +1284 🇻🇮 Virgin Islands, U.s. +1340 🇻🇳 Vietnam +84 🇻🇺 Vanuatu +678 🇼🇫 Wallis And Futuna +681 🇼🇸 Samoa +685 🇾🇪 Yemen +967 🇾🇹 Mayotte +262 🇿🇦 South Africa +27 🇿🇲 Zambia +260 🇿🇼 Zimbabwe +263 Date of Birth Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 If you're under 18, we need your parents or legal guardian written permission Nationality Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic (CAR) Chad Chile China Colombia Comoros Democratic Republic of the Congo Republic of the Congo Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel 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Emirates (UAE) United Kingdom (UK) United States of America (USA) Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Address (optional) Have you ever participated in Indoor or Outdoor Rock Climbing or Bouldering? Yes No Have you participated in rock climbing in the past 6 months? Yes No Have you gotten injured in the past 3 months? Yes No Details (optional) Do you have joint problems that could be made worse by participating in Rock Climbing? Yes No Details (optional) Are you currently taking medication of which the Organizer should be aware of? Yes No Details (optional) Do you have Environmental allergens/Food Allergies of which the Organizer should be aware of? Yes No Details (optional) Do you ever feel faint/have spells of dizziness and/or chest pains during/after physical activity? Yes No Details (optional) Have you ever been told you have a high blood pressure? Yes No Do you suffer from vertigo/lightheadedness when exposed to heights? Yes No IF you have answered YES to one or more questions: Talk to your GP by phone or in person, Tell you doctor about the questionnaire and which you answered yes to. You may be able to participate in Rock Climbing however we do ADVISE for your safety that if you feel uncertain about your health state, speak to your doctor. 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