FUSE Participant form | 0 comments FUSE Participant Registration Participant InformationParticipants name* First Last Date Of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parent or Guardian Name* First Last Home PhoneMobile Phone*Email Emergency contact informationEmergency Contact* Yes No Will the above parent or guardian be the primary emergency contactIf 'no' please list the emergency contact First Last Emergency Contact Phone #Alternate Emergency contact Name* First Last Alternate Emergency Contact Phone*Medical and Allergy InformationMedical Conditions* Yes No Are there any medical conditions that we should be aware of?Medical InformationPlease list any medical conditions or allergies, and any medication or special care they requireMedical treatment* Yes No I authorise the leader in charge of FUSE to arrange for my child to receive such first aid and medical treatment, as a trained first aid person may deem necessary. This may include the calling of an Ambulance. I accept responsibility for payment of all expenses associated with such treatment.Dietary Requirements* Yes No Is your child on a restricted diet?Dietary Requirements If yes, please detailAdditional informationOff-site Activities* Yes I give permission for my child to participate in activities outside of the normal meeting complex - where they are within reasonable walking distance.Transportation to and from eternal events.* Yes I give permission for my child to be transported in private cars arranged by the leaders of the FUSE group. (all transportation will be by full licensed drivers.)Photos and Media Yes I permit photos taken of my child to be displayed on social media or FUSE promotion.Parent or Guardian Signature*Name* First Last Date* DD slash MM slash YYYY