In the space below please give details of the following:-

1. Any Known Infectious Diseases with which Your Child (named overleaf) has been in contact within the last three weeks (e.g. Chicken Pox, Diphtheria, Measles, Mumps, Rubella, Whooping Cough etc.)

2. Any Known Allergies/Sensitivities/Disabilities and details of any known precautions or remedies(e.g. Penicillin, Food Colourings, Travel Sickness, Bed-wetting, Asthma etc.)

3. Details of any Medicines/Diets/Treatments currently being Taken/Followed (including dosage details) & the Specialist and Hospital concerned if appropriate (please include any non prescription preparations, such as cough sweets, herbal medicines).(If he/She has to take any Medication, the bottle(s), jar(s) or other items should be clearly labelled with their name and the exact dosages, and should be handed/notified to the Camp Leader/First Aider before departure.)

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County Camp Form