Medical Conditions Form

To ensure that we provide the best possible service for all those on our children’s activities we request that we have a completed Medical Conditions form.

Within the medical conditions section, please state any medical condition your child suffers from (E.g. Asthma, Epilepsy, Diabetes, and Autism etc.) or details of any other condition which may affect their ability to participate fully in the activities provided. We would be grateful if you can also provide additional information on how this may affect your child participation and methods we can use to make your child’s experience a successful one.

If your child does not have any medical conditions nor allergies please indicate this.

Once received we update your child’s membership record on our computer system with the declared information. This information is available to staff who have a specific requirement within their role at Edge Hill Sport and will not be passed onto any third party.

This can be undertaken by completing the form below or printing off the form and handing to your child’s coach / teacher.

EHS Medical Conditions Form

Your Child's Name (required)

Your Child's Date of Birth (required)

Your Child's Edge Hill Sport Membership Number (if known)

Medical Conditions (required)

Allergies (required)

If any, how can we help?

I hereby certify that to the best of my knowledge the information I have given is accurate and correct.

Your Name Name (required)

Relationship to Child (required)

Date

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