(Please write clearly and complete ALL sections on both sides of this form)
In an emergency please contact:- Participants Family Doctor If receiving Hospital treatment
please indicate national/international dialling codes
Emergency Permission I give my permission for any Frylands Camp Site First
Aider/Paramedic to give treatment for any illness orinjury during the camp. I also give my permission for anyFirst Aider/Paramedic/Authorised Leader to give consent
for any necessary hospital/medical treatment provided
reasonable attempts have been made to contact me.
This must be signed by the holder of Parental Responsibility if the camper is under
16 years of age during the duration of the camp and by the participant if over 16. Medical History Does the participant have any significant Medical History? International Participants Only:
(e.g. any operations, heart problems, epilepsy, diabetes,
Statement of Medical insurance
asthma). Please list anything you may think significant:-
I have made adequate provision to cover all medicalcosts incurred in the UK. Medication
Does the participant take any medication? YES / NO Please list ALL medication, regular or occasional, with
dosage and storage instructions. It is ESSENTIAL thatthe participant brings enough regular medication for the
duration of the camp, in their original containers, clearly
Please ensure the policy certificate is in the participants possession
labelled with name, product and dosage details. List overleaf Participants Own Medication List Dosage Details (quantity, times of day, storage, etc)
Participants under 16 should give their medication to their contingent leader for safe keeping, however inhalers should be kept with the individual, with a spare being given to the Leader. Medication Available on Site
The following are available from the First Aid team, please indicate which can or cannot be used
Dosages will be in accordance with the manufacturer's/supplies recommended doses.
Ibuprofen (tablets & elixir) - not for asthmatics
Chlorphiramine e.g Piriton (tablets & medicine) - for allergies
Antacid e.g. Gaviscon, Rennies (tablets and medicine)
Insect bite cream, e.g. Waspeze, Anthisan
I give permission for the above, as indicated, to be given at the appropriate dose.
Participants are expected to supply their own sun creams/blocks/moisturisers. We request that participants who wear glasses bring a spare pair if possible, participants who wear contact lenses must bring sufficient supplies.
Significant Medical history
Please indicate below any Medical History we shold know about, particularly any current treatment, or any treatment,surgery or investigations in the last six months.
please continue on additional paper if required
Information detailed on this document will be held in accordance with UK law regarding Data Protection, with access beinggranted to authorised staff only.
Decreto No. 22-2000 PRESIDENCIA DE LA REPÚBLICA DE NICARAGUA El Presidente de la República de Nicaragua. En uso de sus facultades que le confiere la Constitución Política. HA DICTADO REGLAMENTO DE LA LEY DE DERECHOS DE AUTOR Y CONEXOS1 ARTO. 1.- Objeto. El presente Decreto tiene por objeto reglamentar las disposiciones de la Ley de Derechos de Autor y Derechos C
PURIM SHPIEL 5770 Brattleboro Area Jewish Community Sunday, February 28, 2010 — 3PM Mr. Rogers Esther Bear Kermit the Frog Oscar the Grouch Howdy Doody Telebubby: Dinky-Stinky Telebubby: Tipsy Mr. Rogers theme Sesame Street theme Rainbow Connection Love Trash Howdy Doody theme Teletubbies theme Music cue : Mr. Rogers th