Under 18 Medical Form

Student
First names ________________Surname __________________Date of Birth___

Address__________________________________________________ Post Code___________

Parents/Guardians
First contact__________________________________________________________________

Address _____________________________________________Post Code___

Phone Home______________________Work______________Mobile___________________

Second contact_______________________________________________________________

Address _____________________________________________Post Code___

Phone Home______________________Work______________Mobile___________________

Alternative (e.g. Grandparent, Aunt ) _________________________________

Address _____________________________________________Post Code___

Phone Home______________________Work______________Mobile___________________

Medical Conditions or Impairments

Does the student have any allergies? e.g. elastoplasts, penicillin, foods? YES/NO
Does the student have any medical conditions which require regular medication?
e.g. diabetes, asthma? YES/NO
If medication may be required during training (including administered by others if the student is incapacitated) please give an explanation of what is required to the course administrator and the Senior Instructor running the course.
Has the student any medical conditions which should be notified to hospital casualty? YES/NO
Is the student taking regular medication which should be notified to hospital casualty? YES/NO
Does the student have any other relevant medical condition? YES/NO
Is the student suffering from any injury? YES/NO
Does the student have any physical or mental disabilities? YES/NO
Does the student have any learning or behavioural needs? YES/NO
If the answer to any of the above is YES please write details overleaf and go through them with the course administrator or Senior Instructor. (Who is also the club safeguarding officer.) This may be done privately and in confidence.

Name of GP_____________________________________Phone______________________

Address____________________________________________________________________

Training and Medical Permission
I give permission for the above named student to receive sailing or powerboating training from TSC. I give the TSC Training Principal or his representative permission to administer First Aid to the above named student and to take him/her to hospital if judged necessary. I give full permission for treatment to be carried out in accordance with the hospital’s diagnosis and for the Training Principal or his representative to sign any documents on my behalf should all efforts to contact me or others named above fail.

Signed____________________________Name________________________Parent/Guardian

Photo/Video Permission
Video and still photos may be taken to aid training and for the enjoyment of participants and family and TSC members. These will only be shown to participants and family and TSC members.
If TSC or the RYA wish to use any photographic material for external publicity specific permission of those appearing will be sought.
Permission
I agree to the above named student being included in still/video photography of training activities.

Signed__________________________Name__________________________Parent/Guardian

Swimming declaration
The student can swim 25metres and is confident in water. YES/NO

Signed___________________________Name_________________________Parent/Guardian

Queries sarahpiper101@gmail.com

Insurance TSC is insured under the RYA Club Insurance Scheme including Sail Training Indemnity. TSC, TSC Volunteers, RYA Coaches, RYA Senior Instructors or RYA Instructors do not accept responsibility for any loss, damage or injury suffered by persons and/or their property arising out of or during the course of their activities whilst training and/or coaching and/or instructing unless such injury loss or damage was caused by, or resulted from negligence or deliberate act.

Data Protection The personal information provided and detailed on this form will be held, used and deleted in accordance with Tynemouth Sailing Club’s Data Protection Policy and Procedures.