Medical information form

For all Adventuring Angel events we ask that everyone completes the following health form.

This is to ensure that we can meet everyone’s needs and respond effectively should an emergency arise.

First name

Last name

Your address

Date of birth

Home phone

Work phone

Mobile phone

Email address

Next of kin name

Relationship to you

Doctor / surgery

Doctor / surgery address

Tick this box if you or your child suffer from asthma / bronchitis

Tick this box if you or your child suffer from sight / hearing difficulties

Tick this box if you or your child suffer from mobility issues

Tick this box if you or your child suffer from a heart condition

Tick this box if you or your child suffer from diabetes

Tick this box if you or your child suffer from epilepsy

Tick this box if you or your child suffer from allergies (e.g. nuts, pollen, materials)

Tick this box if you or your child suffer from bee or wasp stings (please describe below)

Additional details or other illnesses

Do you give permission for Adventuring Angels staff to apply sun cream to exposed areas of skin (if child is unaccopanied)?

Do you give permission for Adventuring Angels staff to apply insect repellant to your childs skin?

Do you give permission for Adventuring Angels staff to administer Priton if required?

Do you give permission for your child to participate in all forest school activities, including fire-making and tool use?

I confirm that the information on this form is accurate and true to the best of my knowledge

Empowering individuals and communities to be their best selves.

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