Parent/carer consent form


Whilst at EduDiverse your child will be taking part in an adventurous activity which will involve some personal risk. It is a legal requirement that before commencing any activity you fully complete the following medical declaration. The information will help us to keep your child safe and structure an effective training program for them. 

Parent consent form

Date of birth:

Has their doctor prescribed any medication during the last 3 months? If yes please give details below:

What are they currently receiving treatment or taking medication for? Please tick below:

Do they suffer from any deficiency or impairment with their hearing? Please tick below:

Do they suffer from any defect in their vision? Please tick below:

Do they have any restriction of movement of their joints or limbs? Please tick below:

Do they have any other restrictions in their movement (neck or back for example)? Please tick below:

Do they suffer from any weakness or recurring injury to their joints, limbs, back or neck? Please tick below:

Do they suffer from any allergies? If yes, please explain below:

Do they suffer from Asthma? Please tick below:

Do they suffer from any other health conditions not mentioned above? Please explain:

My child can swim 25 metres unaided:

My child is water confident:

My child is a poor swimmer:

My child can ride a bike confidently:

My child cannot ride a bike: