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Registration form 3 – Emergency Medical and Contact Information

Emergency Medical and Contact Information

Health Card Number(Required)

Does the participant have any life-threatening allergies?(Required)

Yes

No

To what(Required)

Is the participant required to wear a medical alert bracelet?(Required)

Yes

No

Is the participant required to carry an epi pen? Yes(Required)

Yes

No

Do they need help administering?(Required)

Yes

No

Anything else we should know

Does the participant take medication daily?(Required)

Yes

No

Medications(Required)

Will they need to take it while at EFL?(Required)

Yes

No

Please include dosage and times.

Do they need help?(Required)

Yes

No

Charitable Registration Number: 796536290 RR0001

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