child-med-info-update – ALL FOR SPORT

To comply with Health and Safety and Child Protection in sport, please read and complete the following section in full.

Child Name*

Date of Birth*

School Year*

1. Does your child have, or ever had any of the following:

Heart or Lung conditions (Inc. Asthma/ Bronchitis)*

Yes

No

Please provide details*

Experienced Fainting or Dizzy spells*

Yes

No

Please provide details*

Diabetes*

Yes

No

Please provide details*

Any Joint / Muscular conditions*

Yes

No

Please provide details*

2. Is there any other condition that our coaches must be aware of to allow your child to participate safely in the After School Club?

Does your child require an Epipen?*

Yes

No

Please provide details*

If yes please ensure our coaches have your child’s EPIPEN action plan. Your child will not be able to attend the Camp without it.

Is your child/ren on the SEN register or has an EHCP ?(if Yes contact 07761 678535)*

Yes

No

Please provide details*