Bryanston Sports Courses Medical Form

To enable us to make contact with you in an emergency whilst your son/daughter is in our care please complete the form below.

If any of this information should alter between now and the course start date please ensure that you notify us immediately.

Child First Name* Child Surname* Please provide an emergency contact number in case we need to contact you while your child is on the course* Alternative emergency contact number Course attended* Name and Address of Doctor* Telephone Number of Doctor's Surgery*

Has your son/daughter been immunised for tetanus?*YesNo

Date of immunisation (mm/yy)

Allergies, Drug Sensitivities

Does your child suffer from any allergies?*YesNo

If you have answered Yes, please give details Name of drug Symptoms

Current Medical Treatment

Is your child having treatment, investigations or medical attention of any kind now? Please give brief details of any drugs etc. that they are taking

Asthma
Does your child have a tendency to wheeze or cough, especially at night, after exercise, or in the cold?

Please give details, including any treatment.

Hay Fever
Does your child suffer from Hay Fever or any other form of Allergy?

Please give details, including treatment.

General

Does your child have any other problem that you think we should be aware of?

I hereby authorise the nurse to administer Paracetamol or Ibuprofen as appropriate

Authorisation given*YesNo

Parent/Guardian First Name* Parent/Guardian Last Name*

All information provided in this form is deleted at the end of a course so even if your child has attended one of our courses previously we still require you to complete a medical form.

Bryanston Sports Courses Medical Form

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