<p> Child Health - Fitness to Participate</p><p>Activity details and any associated risks are outlined in an accompanying document. The BBC will treat the medical information about your child as confidential. Declaration of any illness or specific requirement will only limit your child’s participation where there is a risk to health or safety.</p><p>Name of Programme: Recording Date: </p><p>S E C T I O N 1 : Ab o u t t h e C h i l d</p><p>Name: Address: Tel No: Date of Birth Has the child EVER suffered from any of the following complaints? Asthma y n Skin y n Allergies y n Heart y n Complaints problems Epilepsy y n Back y n Migraines y n Phobias y n Problems If yes please give details:</p><p>Does the child have any specific requirements, e.g. sight, hearing dietary or other? If yes please detail:</p><p>Has the child had any major illnesses or operations in the last 3 years? If yes please detail:</p><p>Is the child on any form of medication, if so what type and for what?</p><p>S E C T I O N 2 : Ab o u t t h e C h i l d ’ s D o c t o r</p><p>Name: Address: Tel No: Please sign below to confirm that a) the child is physically fit to participate in the programme; b) you consent to the BBC contacting the child’s GP if there is a need to clarify the child’s fitness and c) the above information is correct. Signed: Print Name: Date: </p><p>Privacy Notice Personal information collected for the purposes of [this record] will be used to identify [those at risk, and those involved in controlling risk, from this or similar activities and to fulfil the BBC’s obligations under Health and Safety policy and legislation]. It will be retained for up to [6] years after [the expiry of the activity]. It may be shared with other organisations, including our agents and contractors, with whom [the risk or the control of risk is shared]. Advisable to check the Corporate Retention Schedule for the appropriate retention period</p>