Active Outdoor Kids
Medical and Consent Form

It is a program requirement for all participants to complete this form prior to participating in the Active Outdoor Kids Program.

Please see our Privacy Policy regarding keeping your personal information safe.

Medical and consent form

Please complete this form to participate in the Active Outdoor Kids Program.

First Name

Last Name

Date of Birth

Emergency Contact details

Emergency contact phone

Are you suffering from a medical condition, illness, or injury?

Yes

Do you take any medication?

Yes

Do you have any of the following conditions?

Asthma

Epilepsy

Anaphylaxis

Diabetes

High blood pressure/fainting

None

Other - details below

If you answered yes to any question, please elaborate

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Outdoors NSW & ACT is proudly supported by Office of Sport. The Strategic Partnership funds specific projects that support the advancement of the outdoor recreation sector.

Outdoors NSW & ACT is richer for understanding the importance of our country’s beginnings and the traditional ownership, care, and custodianship by Aboriginal people. We pay our respects to Elders past and present and all Aboriginal people. We hope that we may continue the discussions and action to educate our future generations on this important culture for Australia and the world.

Follow ONSWACT :

info@outdoorsnswact.com.au

Phone: 1300 964 246

ACN 657 112 260

View our Privacy Policy 2022

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