If you answer ‘yes’ to any of the following, please give details in space provided.
Has the named participant ever suffered from any of the following conditions: Diabetes, Asthma, bad period pains, Migraine, Epilepsy, or any other illness?
Is the named participant allergic to anything (e.g. antibiotics, penicillin, elastoplast, aspirin or any such medicines, any particular food etc.)?
Is the named participant receiving any medical treatment or on any prescribed medication?
Does the participant have any disabilities, additional needs and/or behavioural difficulties?
Details of any medication to be taken, include frequency and any relevant side effects?
Does the participant have any other additional needs? (Dietary, wheel chair access, etc).
Any other relevant information
The medical information is correct to the best of my knowledge and in the event of illness or accident requiring hospital treatment I understand that the responsible person at the club/county will make every effort to contact me. In an emergency doctors/surgeons will make the decision regarding the necessary treatment without my consent.
I have read and understood the attached information and hereby give my consent for my son/daughter to take part in activities organised by the YFC.I understand that the NFYFC insurance policy is available on request. I am aware that while the adults in charge of the event will take all reasonable steps to protect all participants from harm, they cannot necessarily be held responsible for any loss, damage or injury suffered during or as a result of the activity.
I understand that I have a responsibility to inform the club/county of any changes to this information to ensure leaders have the most current information. If this form is completed incorrectly the club/county will contact you to ascertain the relevant information.