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Blue Kangaroo
/immersion program
We need you provide detailed information about allergies or special medical conditions you may have. This information is critical to your registration, so we recommend you fill in the fields carefully.
/supplementary data
Medical data:
Allergies (animals, plants, food, medicine...) : ____________________________________________________________
Have you had any major surgery or serious illness? : ___________________________________________________
Do you have a chronic condition such as diabetes, epilepsy, etc..? : ____________________________________
Diet : ____________________________________________________________________________________________________
Do you suffer or have suffered nervous, digestive disorders or psychological? : ________________________
Is there any medical treatment next? : __________________________________________________________________
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