Medical and Emergency Form for Under 16s

Be aware that you can’t participate in any water sport activity if you can’t swim.

Contact Details

Please fill in your contact details.

Guardian/Parents Firstname:
Surname:
Email:
School or Birthday Party or School Group Name (if applicable):

Participant Information

Is this related to an Event, School, Group, Birthday etc?*
School Term*
Date*
Firstname*
Surname*
Gender*
Date of Birth*
Home Address*

Emergency Contacts

First Emergency Contact - please enter Name, Relationship, Contact Number in the three boxes provided below*
[1]
[2]
[3]
Secondary Emergency Contact - please enter Name, Relationship, Contact Number in the three boxes provided below
[1]
[2]
[3]

Health Information

Doctor's Name
Surgery Phone Number
It is your responsibility to make know any medical conditions that may affect the participant during the activities associated with the programme on offer. Therefore, please provide as many details as possible. Has the participant ever suffered from any of the following conditions?
Asthma/Bronchitis
Heart Conditions
Fits, Fainting or blackouts
Severe Headaches
Diabetes
Travel Sickness
Allergies to Medication
Any other allergies (including food)
Any other illness or disabilities you think we should be made aware of
If you answered yes to any of the above please provide details including current medication:
Please be aware that your child can’t participate in any watersport activities if they can’t swim.*
Yes

Terms and Conditions (Medical Details)

1. Please be aware that every child who is participating in our water sport programs needs to be able to swim.

2. I agree to my child’s/ward’s attendance at the program noted above. In the case of an emergency, I authorise the program staff, where is it impracticable to communicate with me, to arrange for my child/ward to receive such medical or surgical treatment as may be deemed necessary. I also undertake to pay or reimburse costs which may be incurred for medical attention, ambu-lance transport and drugs while my child/ward is enrolled with the program.

3. I understand that although Balmoral Water Sports Center and its service providers attempt to mini-mise any risk of personal injury within practical bounda-ries accidents do happen and all physical activities carry the risk of personal injury.

4. I acknowledge that there is an inherent risk of personal injury in physical activities that will be undertaken as part of this program.

 The parent/Guardian has read and understood the above conditions and agrees to be bound thereby

Please tick the box if you agree to the below conditions*
I agree
Please tick the box if you agree to the below conditions*

Permission for Balmoral Water Sports Center 

Students at Balmoral are regularly photographed while participating in sailing activities. These photos may be used in our website
Where a photo is used in this way, prints will be made available to you on request.

 

I agree