24-25 February: Animal Sleepover Adult Health Form
You can complete this form whenever you want but please note that you are responsible for notifying us of any changes to your answers between the date that you complete it and the date of the camp
Full name: *
Your answer
Date of Birth: *
Please use the format DD/MM/YY
Your answer
NHS Number: *
Your answer
Emergency contact name: *
This must be an adult who will not be on the camp and will be available throughout in case of emergency
Your answer
Emergency contact address: *
Your answer
Emergency contact telephone number: *
Your answer
Name of doctor: *
Your answer
Doctor's phone number: *
Your answer
Details of any allergies:
eg penicillin, aspirin, particular foods
Your answer
Details of any special dietary needs:
eg vegetarian, vegan, lactose intolerance, coeliac
Your answer
Please type your name as confirmation of the statement below: *
I will inform the Camp Leader if any of the information given on this form changes before the event takes place or if I have been in contact with any infectious diseases in the three weeks before the Camp.
Your answer
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