Queen and contact details from earlier sections are summarised here without duplicate entry. Check or correct them in
1. Queen details and 2. Parent / Legal Guardian .
Parents and Guardians are responsible for providing Queen Mode with accurate and current information relevant to the Queen’s ability to safely participate. Queen Mode should be notified promptly of any significant changes to the Queen’s health, circumstances or ability to participate.
Sensitive information is collected only to support safe participation, emergency response and enrolment administration. See the Privacy Policy .
Does the Queen have any medical condition, injury, physical limitation or other circumstance that may affect participation in physical activity? * required
Details
Only if you chose “Yes” above. Required in that case.
Does the Queen have any allergies that Queen Mode should be aware of? * required
Details
Only if you chose “Yes” above. Required in that case.
Is the Queen currently taking any medication that may be relevant to participation or emergency care? * required
Details
Only if you chose “Yes” above. Required in that case.
Are there any other health, safety, accessibility or wellbeing considerations Queen Mode should be aware of? * required
Details
Only if you chose “Yes” above. Required in that case.
Has the Queen been advised by a medical or health professional to restrict or modify physical activity? * required
Details
Only if you chose “Yes” above. Required in that case.
Conditions relevant to emergency care
Emergency medication
Name, where it is kept during sessions, and instructions for use.
Current injury or restrictions
Accessibility or support requirements
Medical clearance
Queen Mode is not a medical provider and cannot determine whether a Queen is medically fit to participate. Where a relevant condition, injury, restriction, recent illness or other concern may affect safe participation, medical clearance may be required before participation.
I confirm that, based on the information available to me, the participant is medically cleared to participate subject to any conditions listed below.
Is a doctor’s certificate or medical clearance required? * required
Conditions / restrictions
This and the following fields apply only if you chose “Yes” above.