Economic Tools for Conservation -- Medical Form

Medical form for participants

Name

Date of Birth

Emergency Contact (name, telephone number, and email)

Allergies (to specific food, drugs, smoke, etc.)

Dietary Needs / Preferences (please include any foods you cannot eat)

Medical History (diseases or illnesses)

Blood type (if known)

Other Information

Video and Photograph Release

I consent to Conservation Strategy Fund using my image in photographs and video footage from the course for the production of promotional and educational materials across a range of media.

Yes