Emergency contact name Relationship to the Child, Parent Carer Young Person or Adult at Risk Other (specify) Emergency contact number Alternative contact name Alternative contact number / Adult at Risk Doctor’s Name: Address: Contact number: Medical Information Does the or adult at risk Yes No have any conditions requiring medical treatment If yes please provide details: and / or medication? Does the child or adult at Yes No risk have a disability? If yes please provide details: Does the child, or adult at Yes No risk have any challenging behaviour/difficulties? If yes please provide details: Does the child, or adult at Yes No risk have any allergies? If yes please provide details: Does your child, or adult at risk have any specific Yes No dietary requirements? If yes please provide details: Does your or adult at Yes No risk have any disability or additional support needs? If yes please provide details: I have received comprehensive details of the above activity and am aware of RLSS UK Safeguarding Policy. By returning this completed form, I consent to……………………………………………………………………. (name of participant) taking part in the activities stated and I understand that I will be kept informed of these activities. I understand it is my responsibility as a parent or carer to send the medication with for……………………………………………………………. to the activity clearly labelled with the child’s or adult at risk‘s name. The person responsible for the activity for e.g. coach, instructor, trainer, administrator, club official, event organiser will look after the medication whilst the child or adult at risk is engaged in activities. I am familiar with and agree to support all RLSS UK relevant codes of conduct.
Emergency contact name Relationship to the Child, Young Person or Adult at Risk Parent Carer Other (specify) Emergency contact number Alternative contact name Alternative contact number / Adult at Risk Doctor’s Name: Address: Contact number: Medical Information Does the or adult at risk have any conditions requiring medical treatment and / or medication? Yes No If yes please provide details: Does the child or adult at risk have a disability? Yes No If yes please provide details: Does the child, or adult at risk have any challenging behaviour/difficulties? Yes No If yes please provide details: Does the child, or adult at risk have any allergies? Yes No If yes please provide details: Does your child, or adult at risk have any specific dietary requirements? Yes No If yes please provide details: Does your or adult at risk have any disability or additional support needs? Yes No If yes please provide details: I have received comprehensive details of the above activity and am aware of RLSS UK Safeguarding Policy. By returning this completed form, I consent to……………………………………………………………………. (name of participant) taking part in the activities stated and I understand that I will be kept informed of these activities. I understand it is my responsibility as a parent or carer to send the medication with for……………………………………………………………. to the activity clearly labelled with the child’s or adult at risk‘s name. The person responsible for the activity for e.g. coach, instructor, trainer, administrator, club official, event organiser will look after the medication whilst the child or adult at risk is engaged in activities. I am familiar with and agree to support all RLSS UK relevant codes of conduct.