Annie Jnr. Medical Information 2024
Annie Jnr. Production Medical Info 2024
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Email *
Child's First Name *
Child's Last Name *
Date of Birth *
Private Health Insurance Provider *
Private Health Insurance Membership # *
Medicare # *
Child's # on Medicare Card *
Medicare Expiry Date *
Do you have Ambulance Cover? *
Required
Health Care Card # (if applicable) *
Will your child need to take any tablets or other medication during the course of the 2024 Production of Annie Jnr? If Yes, please give details.
Please note: SHYAC volunteers cannot administer medication therefore the parent/guardian MUST administer
 *
Has your child been taken off medication recently? If Yes, please give details. *
Has your child had any surgery, injuries, bone or joint problems? If Yes, please give details. *
Please indicate if your child has had any of the conditions below. Provide additional details if necessary in the next box.  *
Required
Additional details to any medical conditions for your child.
I give authority to the SHYAC tutors/volunteers whilst my child is in their care during rehearsals and shows of the 2024 Production to decide upon and obtain medical assistance and treatment for my child (doctor, dentist, ambulance, hospital) in the event of an emergency. I have provided my child’s medical information and Medicare and/or health fund details. I understand that this form and the Medical Information form may be provided to any medical treatment provider. I agree to cover the costs of any medical assistance and treatment that is required and may be incurred on behalf of my child. I understand that SHYAC tutors/volunteers will make every effort to contact me (or the persons I have nominated on the Emergency contact form and hereby authorise to make decisions in the event of such an emergency) in an emergency and inform me of any such emergency as soon as is practicable in the circumstances. *
Required
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