Health + Safety Information

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Welcome to the inaugural DEYA High School Production of Legally Blonde The Musical!

Please take the time to fill out this form prior to the start of rehearsals. The information provided allows us to ensure the safety of your child while working on the production.

Student's Name *

Student's Position in Production

Cast

Crew/Production

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Student's Health Card Number *

Name of Family Doctor and Affiliate Office *

Student's Allergies/Intolerances *

Does your child have any other special medical or behavioural needs? *

Do you give DEYA permission to call a doctor or take/send your child to the Emergency Room in case of accident or serious illness? *

Yes

Does your child carry an EpiPen or equivalent auto-injector? *

Yes, an EpiPen

Yes, an equivalent auto-injector

If applicable: What is the location of your child's EpiPen/auto-injector?

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