Medical Consent FormForm for camps and training daysTrainee Name(Required)Name of traineeTrainees Date of Birth(Required) DD slash MM slash YYYY Emergency Contact Name(Required)Parent/GuardianEmergency contact number(Required)Additional Emergency Contact NumberDates attendingI authorise NSSA/Impulse staff on the Camp or training day, if necessary, to give consent on my behalf for an anaesthetic to be administered or for any other urgent medical treatment to be given to or surgery to be carried out on me/my child on the advice of a qualified medical practitioner.(Required)YesNoI set out below (or on an attached note) details of any medical condition from which I/my child is suffering, together with details of the treatment required and medication currently being taken or carried, along with any Dietary Requirements(Required)CAPTCHA
