Child

This form should be completed by the guardian of each minor participating in the set event.
RM_Stats
Guardian's Details
Parent's Username
Guardian's Email Address^*
Guardian's Email Address
Relationship with child^*
Create Child's Account Details
Username^*
Email^*
Phone

Child's Personal Details
First Name
Last Name
Gender
Male

Female

Date of Birth
School Name
Grade

Dietary Requirements
Diet^*
Normal

Kosher

Halaal

Vegan

Vegetarian

Other

Other Diet: Please specify^*
Food Exclusion
No Red Meat

No Tin Food

Lactose Intolerance

No Dairy Products

No Chicken

No Fish

No Pork

No Nuts

Other

Other Food Exclusion: Please specify
Health Questionnaire
What physical disabilities or conditions do you have that might affect your participation in this activity including operations illness, broken bones in the past six months?
Asthma

Diabetes

Heart Conditions

Hemophilia

Seizures

Fragile X Syndrome

Wheel Chair

Other

Other Physical disabilities: Please specify^*
Any allergies?
Bee stings

Crustaceans (Shellfish)

Drug Allergy (Please specify)

Eggs

Fish

Latex

Milk

Nuts

Sesame

Pollen

Soy

Wheat

Other

Other Allergies: Please Specify^*
Last date of immunisation (tetanus, booster, etc.)?
3 Month Ago

3-6 Month Ago

6-12 Month Ago

12-24 Month Ago

List any medications being taken?
Authorisation for Medical Treatment
Please complete the following as thoroughly as possible. The information will be used only by the program leaders and any emergency medical personnel. All material is confidential.
Medical Aid Name
Main Member
Medical Aid Number
ID Number
Main Member's ID Number
Photography
I give consent for photographs/videos to be taken of my child while at a First One Adventures’ camp. These are to be used solely for the purposes of record keeping and promotion of First One Adventures. All personal information collected in this form will be used for the purposes of First One Adventures and will not be disclosed to any external or third parties.^*
Yes

No

Water Activities
Swimming Confidence^*
Post Event
I consent my child to participate in post-camp communication with their event leaders from camp. All our communications between leaders and campers are monitored by the Koolisa director.
I consent my child to keep in contact with event team^*
Yes

No

About

Kooilsa is a software application for parents to manage registrations for their children's school events. The application managers kids data used by the host and restrictions pre-set by guardian.

About

Trust

KOOLISA