Fill out the form below Name: D.O.B: Contact Number: Address: Emergency Contact Number: Please inform us of any medical or behavioural details staff need to be made aware of in order to best support you during sessions: Condition(s): Action to be taken should above occur whilst in session Do you give your consent to take your photograph? YesNo Please note whilst staff will do their very best to support clients we cannot give or store any medication. Have you had your first dose of COVID 19 Vaccination? YesNo Have you had your second dose of COVID 19 Vaccination? YesNo Sign your name:
