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Health form.xls

HEALTH FORM
(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 Allergies
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.

Source: http://www.frylandswood.co.uk/Health%20Form.pdf

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