YOUNG VOICES OF MELBOURNE MEDICAL INFORMATION 2018 Date: The information below will help us to provide the best possible care of your child when he or she is at a Young Voices of Melbourne rehearsal, camp, tour or other activity. All information is held in confidence. NAME Name of choir member: Date of Birth: CONTACT DETAILS Address: Home Phone: member’s mobile (if applicable): 1st Parent’s name: 1st Parent’s mobile number: 2nd Parent’s name: 2nd Parent’s mobile number: Parent’s email: Choir member’s email (if applicable): Emergency Contacts Name and contact numbers (if we can’t contact parents): MEDICAL INFORMATION Family Doctor (name and number): Family Dentist (name and number): Medicare Card Number: Name of any Medical or Hospital Fund: Name of Policy: Details of any chronic ailments, eg asthma, diabetes, epilepsy, weak joints, recent operations and so on: Details of any regular medication: Date of last tetanus injection: Do you permit the administration of paracetamol tablets/syrup for pain-killing (yes/no):
YOUNG VOICES OF MELBOURNE MEDICAL INFORMATION 2018 Date: The information below will help us to provide the best possible care of your child when he or she is at a Young Voices of Melbourne rehearsal, camp, tour or other activity. All information is held in confidence. NAME Name of choir member: Date of Birth: CONTACT DETAILS Address: Home Phone: member’s mobile (if applicable): 1st Parent’s name: 1st Parent’s mobile number: 2nd Parent’s name: 2nd Parent’s mobile number: Parent’s email: Choir member’s email (if applicable): Emergency Contacts Name and contact numbers (if we can’t contact parents): MEDICAL INFORMATION Family Doctor (name and number): Family Dentist (name and number): Medicare Card Number: Name of any Medical or Hospital Fund: Name of Policy: Details of any chronic ailments, eg asthma, diabetes, epilepsy, weak joints, recent operations and so on: Details of any regular medication: Date of last tetanus injection: Do you permit the administration of paracetamol tablets/syrup for pain-killing (yes/no):