Rock school 2 pg2 2011
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This medical form collects information about any special dietary requirements, allergies, medical conditions, emergency contacts, and consent for medical treatment for a child attending camp. It requests the child's name, their GP's contact information, their parent or guardian's name and contact number, and signatures giving permission for first aid, medication if needed, and for the child's photo or video to be taken during camp activities.
Rock school 2 pg2 2011
- 1. Camps Medical Form Special dietary requirements --------------------------------------------------------------------------------- --------------------------------------------------------------------------------- Allergies/Medical Conditions --------------------------------------------------------------------------------- Name of GP --------------------------------------------------------------------------------- Address of GP --------------------------------------------------------------------------------- Telephone --------------------------------------------------------------------------------- number of GP --------------------------------------------------------------------------------- Emergency Contact Name --------------------------------------------------------------------------------- 2 Emergency Contact No --------------------------------------------------------------------------------- Parent/Guardian Name --------------------------------------------------------------------------------- Parent/Guardian Contact No --------------------------------------------------------------------------------- Consent please tick to indicate agreement: I give permission for my child to attend this camp run by SWYM I give permission for my child to receive First Aid if deemed necessary by qualified personnel I give permission for my child to receive paracetamol/Ibuprofen if deemed necessary by qualified personnel Should my child be taken to hospital and you are unable to contact me, I give permission for medical personnel to intervene as necessary Signed: Date: Video and camera footage will be taken during the camp for use during Camp and for SWYM promotional opportunities. By sending a young person to this camp we are assuming your permission for photographs and video footage to be taken Data Protection: The details submitted on this form will be retained on the SWYM Camps database and will be used in distributing information of future camps & events, if you do not want to be sent any further information, please tick this box