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MEDICAL FILE

Date: June 14, 2025

First Participant's Name
First Name*
Middle Name
Last Name*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
PARENT’S OR GUARDIAN’S ADDITIONAL INDEMNIFICATION (Must be completed for participants under the age of 18 ) In consideration of minor(s) (“Minor”) being permitted by El Bloque to participate in its activities and to use its equipment, I further agree to indemnify and hold harmless El Bloque from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Age: *
Do you have any medical conditions we should know about?*
No
Yes
If yes, please explain:
Have you had any recent injuries or medical procedures?*
No
Yes
If yes, please explain:
Are you taking any medications?*
No
Yes
If yes, please explain:
Are you allergic to any medications?*
No
Yes
If yes, please explain:
Do you have any food allergies?*
No
Yes
If yes, please specify:
If necessary, will you accept medical treatment?*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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