Name *Do you have any conditions requiring medical treatment, including medication? *YesNoIf Yes, please give details belowMedical conditions and medication detailed here:Name and Address of your GP *Are you allergic to any medication? *YesNoIf yes, please specify belowPlease specify medication allergies here:Please supply any additional relevant informationEmergency Contact Name *Emergency Contact Home Address *Emergency Contact Home Telephone *Emergency Contact Work Telephone *Emergency Contact Mobile *Alternative Emergency Contact *Please include Name, Home Address, and Home TelephoneAlternative Emergency Contact Work Telephone *Alternative Emergency Contact Mobile *In an emergency *YesNoIn an emergency If it becomes necessary for me to receive medical treatment I hereby give my general consent to any necessary medical treatment and authorise designated Music & Arts Service staff to sign any document required by the hospital authorities. All of the above information is covered by the Data Protection Act 2018. PhoneSubmit