© Girlguiding 2014 Health Information 1 of 3
Part I – to be completed by the event coordinator or ﬁrst aider
Name of event/activity
Start date End date
Person responsible for ﬁrst aid at the event
Part II - to be completed by:
parents* of participants (including children of volunteers) under the age of 16
members of The Senior Section aged 16 and over
adult volunteers attending a girl event (if adults wish to keep their health information conﬁdential they may
carry it in a sealed envelope that will be opened only in the case of an emergency).
NOTE: Over-16s attending a 16+ event are NOT required to complete this form.
Surname Membership number
Date of birth
Date of last anti-tetanus injection
GP’s telephone number
GP surgery name or GP’s address
The following medication will be available at the event. Please tick to indicate which may be given to your
daughter if required (girls under 16 only).