MAYO
VERANO
SUMMER
BIRTHDAYS
CAMPING ESCOLAR
Medical Administration Permission Form
Medical Administration Permission Form
Contact Us
Child's Full Name:
Child's Age:
Parents Full Name:
Contact Number:
Email:
Medical Condition: (full allergy details)
I give permission to allow the administration of epinephrine by auto-injection (Epi-pen) by the club leader, an unlicensed medical professional in the event that my son/daughter is unable to administer the injection themselves, in the event of an emergency.
Yes
No
Digital Signature of Parent/Guardian:
Thank you for contacting us.
We will get back to you as soon as possible.
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STAFF
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