Medical Information

Page 2 / 3

All child under the age of 18 years taking part in outdoor activities must have this form completed as fully as possible by a parent or guardian, prior to commencement of the chosen activity/ies. All information given will be treated with the strictest confidence.


1. General Medical Details

Does your child have any medical conditions?


Is your child receiving any medication or treatment?


Does your child suffer from allergies? i.e. stings, bites, penicillin, elastoplasts etc


Is your child prone to repetitive sports injuries?


Can your child swim?


Does your have any dietary needs?
i.e. vegetarian, celiac etc (only applicable if ordered packed lunches)


Are there any areas we have not yet covered that you feel may be relevant?


For equipment purposes i.e. wetsuit, buoyancy aid, please provide your child's approx. Height, Weight & Chest Size.


Emergency Contact Details

please provide Surgery Name, Town, Postcode

If the above details are correct, please proceed to the final page - Disclaimer.