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Just Chronic Escapes 2025

Hey Just Chronic Escapers old and new! 

Please take the time to complete the questionnaire. 

love V&K x

Secured
JCE breakaway event 2025
1

Full name

2

Date of birth.

Select a date
JCE breakaway event 2025

⚠️please note that all information given in the next couple of slides of this questionnaire will be kept confidential. It will not be shared with anyone other than JCE team leader Vic and JCE team leader Kirsty. This information may be shared with medical professionals in the event you’re unable to do so yourself.⚠️

3

Do you understand the above statement and consent that information can be shared with medical professionals in the unlikely event you’re unable to do so yourself?

Only select one answer please.
JCE breakaway event 2025
4

Emergency contacts name, relation and number

This is needed in the unlikely event of an emergency
JCE breakaway event 2025
JCE breakaway event 2025