1. Camps Medical Form
Special dietary
requirements ---------------------------------------------------------------------------------
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Allergies/Medical
Conditions ---------------------------------------------------------------------------------
Name of GP ---------------------------------------------------------------------------------
Address of GP ---------------------------------------------------------------------------------
Telephone
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number of GP ---------------------------------------------------------------------------------
Emergency
Contact Name ---------------------------------------------------------------------------------
2
Emergency
Contact No ---------------------------------------------------------------------------------
Parent/Guardian
Name ---------------------------------------------------------------------------------
Parent/Guardian
Contact No ---------------------------------------------------------------------------------
Consent please tick to indicate agreement:
I give permission for my child to attend this camp run by SWYM
I give permission for my child to receive First Aid if deemed necessary by qualified personnel
I give permission for my child to receive paracetamol/Ibuprofen if deemed necessary by
qualified personnel
Should my child be taken to hospital and you are unable to contact me, I give permission for
medical personnel to intervene as necessary
Signed: Date:
Video and camera footage will be taken during the camp for use during Camp and for SWYM promotional
opportunities. By sending a young person to this camp we are assuming your permission for photographs
and video footage to be taken
Data Protection: The details submitted on this form will be retained on the SWYM Camps
database and will be used in distributing information of future camps & events, if you do not want to
be sent any further information, please tick this box