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Medical and Consent Form

Personal Details of Participant


Medical Information

Has the participant had or have any of the following? (please tick)
Is the participant receiving any of the following
If it is considered necessary, do you consent to mild painkillers (paracetamol) being administeres?*
If it is considered necessary do you consent to hypo-allergenic sun screen being provided?*
Has the participant received vaccination against Tetanus in the last 10 years?*

Consent for the visit

He/She is in good health and I consent to him/her taking part in ALL activities set out in the visit information.

I the event of illness or accident, I consent to any necessary medical treatment, which might include the use of anaesthetics.

In the event of any changes to these details, illness or medical treatment occurring after the return of this from and prior to the activity, I will undertake to inform the group leader.

Consent for programmes water sports and water related activities
(e.g. Kayak, Canoe, Sail, Windsurf, Rafting etc.; or activites involving water e.g. Caving, Gorge walking)

Please tick ONE of the boxes below as apropriate to confirm the water capability of your child.*

Ticking A,B,C, or D above confirms your consent to your child undertaking water activities within the programme provided. This information will be passed on tho the provider by the school/college/establishment to allow appropriate adjustments or operating procedures for inclusive participation (as set out in HCC Registration information to providers).