Emergency ContactWhat information do I need to know so that I may provide the best care for your child? Child/ren Name * First Name Last Name DOB * MM DD YYYY 2nd child if required First Name Last Name DOB MM DD YYYY 3rd child if required First Name Last Name DOB MM DD YYYY Information of any long term illness, disability etc Parent/Guardian Name * First Name Last Name Email * Phone * (###) ### #### SPOUSE/PARTNER/BACK UP CONTACT INFO * First Name Last Name Phone (###) ### #### The following people have my consent to pick up my child from NW Fitness Kid/Teens class Allergies/Special Health Conditions * I authorise all medical and surgical treatment, x-ray, laboratory, anaesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver only applies if neither parent/guardian can be reached in the case of an emergency. I Consent Thank you!
