Application Form Medical Professsional Letter 1011 .pdf new .pdf

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Original filename: Application_Form_Medical_Professsional_Letter_1011.pdf new.pdf
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President: HRH THE PRINCESS ROYAL KG KT GCVO QSO

To:
Riding for the Disabled Association (RDA) – Application Form
As part of our application procedures and on-going monitoring of participants’ suitability to take
part in our Group activities, we do at times need information from a medical professional to
ensure the participant will benefit from our sessions.
I am writing to you as a medical professional who is familiar with and understands the medical
conditions of the applicant/participant. I hope you will not find it too much trouble to help with
the information requested below. Please note that you are being asked for information and not
to give consent; this is the responsibility of the person concerned (the applicant/participant) or
their parent/guardian where appropriate.
Thank you in anticipation of your help.
Yours sincerely

Ed Bracher
Chief Executive
1.

Is the medical information, stated in sections 2 and 3 of the attached form,
accurate to the best of your knowledge? If no, please provide more details:

Y/N

2.

Are you aware of any other specific medical conditions or contra-indications
not stated on the form that the Group needs to be mindful of? If yes, please
provide more details:

Y/N

Signature ………………………………………………………

Name …………………………………………

Appointment …………………………………………………

Phone Number ..………………………….

Date …………………………….

Riding for the Disabled Association Incorporating Carriage Driving
Norfolk House, 1a Tournament Court, Edgehill Drive, Warwick CV34 6LG
Tel 0845 658 1082 Fax 0845 658 1083 Email info@rda.org.uk Web www.rda.org.uk
Co limited by Guarantee No. 5010395 Registered Charity No. 244108 Registered Charity No. Scotland SC039473


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