Emergency Medical  / Allergy and Consent Form

In case of an Medical Emergency Skills 2 Fish has my permission to obtain emergency medical treatment for myself or my child(ren).

Participants Name: __________________________________________________________________

Participants DOB: ___________________________________________________________________

 Parent / Guardian’s Name: ___________________________________________________________

Address: __________________________________________________________________________

_________________________________________________________________________________

Emergency Contact: ________________________________________________________________

Contact Phone: ____________________________________________________________________

Allergy’s: __________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Do the participants require an EpiPen:     Yes / No

Medical Conditions: _________________________________________________________________

__________________________________________________________________________________

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Do they require any medication:   Yes / No

I understand that I assume all finical responsibility for any treatment or injuries sustained to myself or my child(ren) while undertaking the course.

Parent / Guardian Signature (if under 18) __________________________________Date: __________

Participants Signature__________________________________________________ Date: _________

Facilator Name and Signature ___________________________________________ Date __________