ࡱ> xzyq` <bjbjqPqP 5>::L2 2 2 2  ^^^8 35ZZZZZ9994444444$7h9b4 5942 2 ZZ48 8 8 j2 8Z Z48 48 8 v/|j  0ZN 01^dv/15035099$09 009Z@8 499944^99935 $  2 2 2 2 2 2  Houghton Harriers and Athletics Club Medical Consent FormAthlete Surname:Forenames: Emergency Contact Please indicate below the person(s) who should be contacted in case of incident/accident: Surname:Forenames:Telephone:Mobile:Surname:Forenames:Telephone:Mobile:Disability The Disability Discrimination Act 1995 defines a disables person as anyone with a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities. Do you consider your child to be disabled?YESNOIf yes, what is the nature of the disability? Visual impairmentHearing impairmentPhysical disabilityLearning disabilityMultiple disabilityOther (please state)OtherMedical History Does your child suffer from any illness, allergy or other medical condition of which we need be aware?YESNOIf yes please give details below, including any medication: I hereby give my consent for Houghton Harriers and Athletics Club to arrange suitable medical care, as necessary, for the above named child in my absence. Signed:Date:(Parent / Guardian) Beta 2 Agonist Inhalers Please note: if your child needs to use a Beta 2 Agonist Inhaler you MUST complete the uk:athletics Inhaler Form which is available from the Club. Please ask one of the coaches for further information. Failure to comply with this rule may result in your child being disqualified from competition.     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