Part 5 Medical Information Health & Consent Form – – Newcastle Fencing Club’ its employees or agents are not trained to provide medical advice and you must consult your General (Medical) Practitioner if you have any concerns about your health, or in the case of a Parent or Guardian, the health of Applicant’ before taking part in a Club Squad Training Programme. ‘The First Name Surname If yes, please give details Yes Do you have any allergies No Do you have any of the If yes, please give details following medical conditions : Yes Asthma Epilepsy Diabetes No Heart conditions Any If yes, please give details Yes Do you take any other regular medication No Please note that it is your responsibility to keep the Club informed of any changes in medication and medical conditions. It may be essential at some time for the Club Coach or Team Manager accompanying your son/daughter to have the necessary authority to obtain any urgent treatment which may be required whilst at a competition or training with Newcastle Fencing CLub. Would you therefore please complete the details on this form and sign below to give your consent. I, being Parent / Guardian of the above named child hereby give permission for the Head ……………………………………. Coach/Team Manager to give the immediately necessary authority on my behalf for any medical or surgical treatment recommended by competent medical authorities, where it would be contrary to my son / daughter’s interest, in the doctor’s medical opinion, for any delay to be incurred by seeking my personal consent. Signature of Applicant : Date : Signature of Parent / Guardian : Date : (if under 18 years) If YES to the the Coach / Squad Rep needs to be notified of the above conditions. This is – to be done by the Membership Secretary
Part 5 – Medical Information – Health & Consent Form Newcastle Fencing Club’ its employees or agents are not trained to provide medical advice and you must consult your General (Medical) Practitioner if you have any concerns about your health, or in the case of a Parent or Guardian, the health of ‘The Applicant’ before taking part in a Club Squad Training Programme. First Name Surname Do you have any allergies Yes If yes, please give details No Do you have any of the following medical conditions : Asthma Epilepsy Diabetes Heart conditions Any Yes If yes, please give details No Do you take any other regular medication Yes If yes, please give details No Please note that it is your responsibility to keep the Club informed of any changes in medication and medical conditions. It may be essential at some time for the Club Coach or Team Manager accompanying your son/daughter to have the necessary authority to obtain any urgent treatment which may be required whilst at a competition or training with Newcastle Fencing CLub. Would you therefore please complete the details on this form and sign below to give your consent. I, ……………………………………. being Parent / Guardian of the above named child hereby give permission for the Head Coach/Team Manager to give the immediately necessary authority on my behalf for any medical or surgical treatment recommended by competent medical authorities, where it would be contrary to my son / daughter’s interest, in the doctor’s medical opinion, for any delay to be incurred by seeking my personal consent. Signature of Applicant : Date : Signature of Parent / Guardian : (if under 18 years) Date : If YES to the – the Coach / Squad Rep needs to be notified of the above conditions. This is to be done by the Membership Secretary