Lollipop Youth Theatre Care Plan Form
Please fill in all questions with full details
Name of Young Person *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
Postcode *
Your answer
Doctors Surgery Name *
Your answer
Doctors Surgery Address *
Your answer
Doctors Surgery Phone Number *
Your answer
Allergies & Intolerances *
Your answer
Medical Conditions *
Your answer
Are there any triggers of your child’s condition *
What are their triggers? *
Your answer
Does your child have any phobia’s that can trigger them? *
Your answer
If your child is triggered during their time with us what can we do to care for them? *
Your answer
Does your child take any medication for their condition or allergies? *
Will your child need medication when in our care? *
Do you agree to bring the medication in a labelled box with the child’s name and details on it. (If it isn’t we can not administer it) *
Do you give permission for our nominated first aider to administer the medication or oversee your child taking it if they are old enough? (Parents will have to fill in the medication book) *
Can you list what we can do to make sure your child gets the best care whilst with us please. What can we do to help them if something happens during their time with us.  
Your answer
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