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Child Information, Medical & Consent Form

Before attending, please fill out the information below. Bookings will be reviewed.

Medical Section

In preparation for physical activity, please tell me about all your child's existing medical and physical conditions and who to contact in an emergency. It is your responsibility to complete this form before your child participates in any physical activity. For conditions that can be affected by exercise, you may be asked to consult your doctor and obtain a written medical note before your child can exercise. All the information you provide will remain confidential.

*PLEASE NOTE IT IS YOUR RESPONSIBILITY TO INFROM ME OF ANY CHANGES TO YOUR CHILD'S MEDICAL OR PHYSCIAL CONDITION DURING THEIR FITNESS SESSIONS

Has Your Child Ever Had An Operation?
Has Your Child Ever Received In-patient Treatment For A Physical or Mental Condition?
Has Your Child Ever Been Seriously Injured?
Does your child have a bone or joint condition that could be aggravated by the proposed physical activity?
Please tick if your child has or does ever suffer from;
Does your child take medicine/prescription/Non-prescription drugs regularly?
Is your child currently on a waiting list for hospital treatment?
Is your child currently under the medical care of a doctor or hospital?
Are you aware, through your own experience or a doctor’s advice of any other physical reason that would prohibit your child from exercise without medical supervision?
I would like to inform you that the muga can become slippery in certain weather conditions. I will make you aware of this when your child trains with me, but I would also like you to agree you're happy to continue for your child to use this surface.

Consent Section

Throughout this section we would like you agree or disagree with us to take and use photographs, videos or  interview, voice or any media we may use for the purpose of advertising, promotional or other commercial purposes.

I give permission for photographs and videos of my child to be taken during sessions
I give permission for photographs and videos of my child to be used on Fitness with Phil website for advertising purposes.
I give permission for photographs and videos of my child to be used by Fitness with Phil on social media. (Facebook & Instagram)
I give permission for photographs and videos which I am included in to be used on social media, Fitness with Phil website and for advertising purposes.
Please tick below to confirm your consent and that you have fully understood the consent requests above.
Please tick below to confirm you have read our company policy around how we store and handle your data and you are happy to submit this form

Thanks for submitting our form

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