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Medical Declaration - Individual {{formidable-field-id-22}}

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Teacher/Parent Name

Booking ID
Date of Event
Your Email
Your Phone Number
How will the medical declaration cover your group?
Who is covered by this medical declaration
Child's Name

Please outline if any members of your group have/require any of the following:

ACCEPTANCE OF RISK & DECLARATION OF NON-DISCLOSURE

I, the parent or legal guardian of the above named person confirm they are fit and able to participate in all the activities on their itinerary. I understand the activities they are participating in, at Cuskinny Court Group Activity Centre, have a number of inherent risks & hazards that are beyond the control of the operator and its staff. I agree to personally assume this risk, in the knowledge that the operator will take every care within their responsibility to protect and maintain health and safety. I sign this consent agreement of my own free will and agree to their terms and conditions.

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Your legal name

Your email address

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Timestamp

Audit

30th March 2023 12:01 pm IST

Medical Declaration - Individual {{formidable-field-id-22}} Uploaded by Cuskinny Court - caitriona@cuskinnycourt.ie IP 93.107.227.71