AAE Participant Medical Declaration Form
Medical Declaration by Participants
It is important that we know of any existing medical condition(s) as it is in your interest and ours.  To help us ensure safety, please complete the following questionnaire fully and honestly.  All information provided on the form will be treated as CONFIDENTIAL.
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Name as in Passport *
NRIC Number or Passport Number *
Blood Type *
Do you have a history of / have you ever had: *
Please give details under "Other" on the box/boxes that you have "CHECKED"
Required
Do you get cold easily? *
Do you require Routine Medication? *
Required
Do you require a special diet? *
Example: No beef
Required
Are you a vegetarian? or Do you require a Halal food menu? *
Required
Do you have any disability? *
Required
Are you pregnant? *
Any medical information that we should take note of? *
Date of last / current Tetanus Immunisation *
Please type "Unknown" if you are not sure
I declare that the Medical Declaration made above is true and correct. *
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