Health Questionnaire

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This form is to be completed to help Mandian Swim School determine whether there are any special requirements or needs that should be taken into account to ensure everyone receives the same dedication and experience during any of our swimming programmes.

Only fill this form in if your child has been allocated a lesson position.

Name*

Child's Name*

Email Address*

Area (Elgin, Lossie, etc)*

Does your child have any condition that could be worsened by physical activity?*

YesNo

Does your child suffer from any condition that could effect their breathing? (e.g. Asthma e.t.c.). If yes please provide information on any treatment that may be required before, during or after physical activity.*

YesNo

Please provide information

Please note any medication/inhalers required.

Are there any other reasons/needs that should be taken into consideration whilst your child is swimming with Mandian Swim School? If so please give as much detail as possible.

I confirm that the information given above is correct and true to the best of my knowledge and that I will ensure that if needed, I will seek a doctors approval for my child/children to undertake a swimming programme with Mandian Swim School.

YesNo

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