Future Camp

Please fill in the waiver below in order to attend a Pho3nix Future Camp

"*" indicates required fields

Camp Name*

Name of Attendee*

Parent/Guardian Name*

Emergency Contact Name*

Phone*

Medical Practitioner Name*

Phone*

Agreement

I, agree to the following:

Name of Child’s Medical Condition/Disability/Allergy or Sensitivity/Injury/Other (including management procedures to be followed)

IMPORTANT: If your child has been diagnosed as anaphylaxic and/or at risk of anaphylaxis, please ensure this information is outlined above and that your child/ren are equipped with an auto injection device (Epi Pen®). Please also note that Pho3nix staff are unable to administer any medications required for existing medical conditions.

Should Pho3nix be unable to contact me, I authorise the following person to be contacted to collect and care (including consent to medical treatment and requesting or permitting administration of medication) for my child:

Emergency Contact Name:
Phone:

In the event that Pho3nix is unable to contact myself or my emergency contact, I authorise for a qualified First Aid staff member of Pho3nix to administer first aid medical assistance or treatment to my child, and to contact my child’s medical practitioner:

Medical Practitioner Name:
Phone: