Volunteer Medical Form

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Please complete this form providing any relevant medical information including emergency contact details. All participants MUST sign the declaration at the end of this form. It is unlikely you will be able to participate unless the form is fully completed. Note - If you are aged under 18 years, this form should be completed by a parent/guardian. 

 

Conditions of Use 

We will store an electronic copy of this form in a secure password protected folder for the duration of your time volunteering with us. After this time the document will be deleted. The signed consent form will be valid for an indefinite period. You may at any time write to Healthwatch Northumberland to withdraw your consent to the use of the information supplied. 

Thank you - we look forward to working with you! (Please select 'Next Page' to continue)