Totara Springs Camp - Medical Form
This profile is designed to assist in the care of all participants at EOTC events, including all adults. One form must be completed for each participant.
I am completing this for: *
Full Name *
Your answer
Classroom Teacher *
Please tick if you are effected by any of the following *
Required
If so, please provide details.
Your answer
For Overnight Events
Have you had any major injuries (breaks or strains) or illness (glandular fever etc) in the past six months that may limit full participation in any activities? *
If yes, please provide details.
Your answer
Are you allergic to any of the following *
Required
If yes to any of the above, please provide details, including treatment required.
Your answer
Dietary Requirements *
Totara Springs, our hosts, will be providing the catering while on camp. We need to let them know if there are any particular dietary requirements.
Required
If you have any other dietary requirements, please provide details.
Your answer
To the best of your knowledge, have you/your child been in contact with any contagious or infectious diseases in the past 4 weeks? *
If yes, please provide details.
Your answer
Is there any information the staff should know to ensure the physical and emotional safety of you/your child? (For example; cultural practices, disability, anxiety about heights/darkness/small spaces/ water, behaviour or emotional problems). *
If yes, please provide details.
Your answer
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