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:


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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Signature Certificate
Document name: Medical Declaration - Individual {{formidable-field-id-22}}
lock iconUnique Document ID: 146980b6bdd01c83d8ba837de402872b019eff8d
Timestamp Audit
30th March 2023 12:01 pm ISTMedical Declaration - Individual {{formidable-field-id-22}} Uploaded by Cuskinny Court - IP