Magic Show Participant Health Disclosure Form
Participant Information
Full Name
Date of Birth
Phone Number
Email Address
Emergency Contact
Contact Name
Contact Phone Number
Relationship to Participant
Health Information
Do you have any of the following? (Check all that apply)
Allergies
Asthma
Heart Condition
Epilepsy/Seizures
Takes medication regularly
Other medical condition
If checked, please provide details
List any medications currently taken
Physical restrictions or limitations
Consent and Signature
I confirm that the information provided above is accurate and complete. I acknowledge potential risks and consent to participate in the Magic Show.
Participant Signature
Date