MEDICAL DATA FORM (Under 18) To be completed by the parent

(PLEASE COMPLETE IN BLOCK CAPITALS)

Course Venue: LOC coaching session 2021

I have read all of the information regarding the training sessions and I agree to my son/daughter taking part and agree that my son/daughter needs to behave in a safe and responsible manner.

Signed:	Date

It is vital that we have as much information about your child as possible, which will be kept private and confidential. This will help us in the event of any problems that may arise. Your child should understand and agree to comply with the conditions and discipline laid down by the staff and appreciate that although staff will supervise and take all reasonable care, some activities, by their very nature, include some element of risk.

Full Name:	D.O.B

Address:

Name and contact numbers of Next of Kin:	Name and contact address of Doctor:

Name

Landline

Mobile	Telephone

Any medical conditions, disabilities, treatment, medication, allergies or any other relevant information? (e.g. must carry inhaler at all times, takes tablets daily, hay fever sufferer etc.)