Kiddie Kove Medical Information - FFL Orlando 2023

FFL Orlando 2023 Kiddie Kove Medical Information

Please complete one form for each of your children with type 1 diabetes or any other medical concern of which we need to be aware. Please be sure to complete ALL fields in order to speed up registration on the first day. Please email [email protected] with any questions you may have regarding completion of this form.

Please be sure to bring a change of clothing labeled with your child's name.
Child's Name(Required)
First Last
Age(Required)
Primary Parent's Name(Required)
First Last
Primary Parent's Cell Phone(Required)
Secondary Parent's Name
First Last
Secondary Parent's Cell Phone
Guardian or Other Adult
First Last
Guardian or Other Adult's Cell Phone
If needed, how would you like us to perform a finger stick to check your child's glucose levels? (Note: we use our own single use, disposable lancets for all glucose checks.)(Required)
At what times would you like us to check your child's glucose levels? (Times are approximate. Check all that apply.)
- 9:30 am (middle of session)
- 11:00 am (start of session)
- 2:30 pm (end of session)
- 4:00 pm (middle of session)
At what BG levels would you like us to alert you?
Higher than (mg/dl):(Required)
Lower than (mg/dl):(Required)
How would you like us to contact you during a session?(Required)
How do you manage your child's diabetes? Check all that apply.(Required)
- Injections (pen or syringe)
- Insulin pump
- CGM
- Loop/OpenAPS
- Other
If other, please describe.
If your child has another medical condition, please advise what it is and what we need to do to assist.
If your child has any allergies, please list them here.
If your child has any allergies, please list them here.
How would you like a low blood sugar (70 mg/dl or lower or rapid decrease shown in CGM) treated?(Required)
If your child uses a CGM and it alarms during your session, would you like to be notified?
How would you like to be contacted?
Cell phone to contact

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FFL Orlando 2023 Kiddie Kove Medical Information

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FFL Orlando 2023 Kiddie Kove Medical Information

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