SayPro Emergency Contact Information A document providing emergency contact details in case of medical emergencies

SayPro Emergency Contact Information

Emergency Contact Information Form

In the event of an emergency during your participation in SayPro Extreme Sports Camp, we require your emergency contact details to ensure prompt and effective communication. This information will be used solely for emergency purposes and will be kept confidential.

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Participant Information

• Full Name:
  • First Name: ____________________
  • Last Name: ____________________
• Date of Birth:
  • MM/DD/YYYY: ____________________
• Phone Number:
• Email Address:

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Emergency Contact Details

1. Primary Emergency Contact Name:
   • First Name: ____________________
   • Last Name: ____________________
2. Relationship to Participant:
3. Primary Emergency Contact Phone Number:
   • Mobile: ________________________
   • Home/Work: _____________________
4. Secondary Emergency Contact Name:
   • First Name: ____________________
   • Last Name: ____________________
5. Relationship to Participant:
6. Secondary Emergency Contact Phone Number:
   • Mobile: ________________________
   • Home/Work: _____________________

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Medical Information

7. Preferred Medical Facility (if any):
8. Primary Care Physician Name (if applicable):
9. Primary Care Physician Phone Number:
10. Known Allergies (medications, food, insect stings, etc.):
11. Current Medications (include dosage and reason, if applicable):
12. Do you have any pre-existing medical conditions (e.g., asthma, heart condition, diabetes)?
    • ☐ Yes
    • ☐ No
      If yes, please provide details:
13. Do you have any history of surgeries or serious injuries that might affect your ability to participate in physical activities?
    • ☐ Yes
    • ☐ No
      If yes, please provide details:

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Consent for Emergency Treatment

14. In the event of a medical emergency, I consent to emergency medical treatment being provided to me. I authorize SayPro Extreme Sports Camp staff, instructors, and medical professionals to take whatever actions are deemed necessary in their judgment to provide medical care, including transportation to a medical facility if necessary.

• Signature of Participant (if over 18):
• Date:
  • MM/DD/YYYY: ____________________

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15. If the participant is under 18, Parent/Guardian Consent is required:

• Parent/Guardian Name:
• Parent/Guardian Relationship to Participant:
• Parent/Guardian Phone Number:
• Parent/Guardian Signature:
• Date:
  • MM/DD/YYYY: ____________________

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Important Notes:

• Confidentiality: All emergency contact information and medical details provided will be kept confidential and will only be used for emergency situations.
• Update Information: Please ensure your emergency contact details and medical information are kept up to date before participating in any SayPro activities.
• Emergency Protocol: In the event of an emergency, the SayPro team will make every reasonable effort to contact the emergency contacts provided above.

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Thank you for providing your emergency contact details. This will help ensure your safety and well-being during your time at the SayPro Extreme Sports Camp.