KAO2013
Medical consent form To be completed in respect of a child under 16 by a parent.
Does your child suffer with any medical or psychiatric condition? Yes
Please ensure this form is completed and brought to registration
No
If yes, please give details
Children will not be admitted to the event without this signed/completed form. The Salvation Army will use your/your child’s information for providing services and will process this sensitive data accordingly. By signing this form you consent to our keeping such records on file during and for a period of 6 months after the event and using them for the above purposes. The information will be stored securely and confidentially at DHQ/THQ. You have a right to ask for a copy of the information and correct any inaccuracies Child’s Surname First Name Date of Birth Address
Does your child have any of the following conditions? Please give any further details as required Epilepsy
Yes
No
Yes
No
Yes
No
Yes
No
Diabetes Asthma
GP’s Name GP’s Phone No. GP’s Address
Anaphylaxis
Date of last tetanus injection