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Junior Membership & Parental Consent Form

Personal details

Child’s Name                        ……………………………………………….

Address                                 ……………………………………………….

                             .………………………………………………

                             .………………………………………………

Post code                               ………………………………….

Tele number                         …………………………………

D.O.B                                         ………………………………….

Medical Information.

Does your child have any medical conditions/allergy’s? YES / NO. If yes please give details.

…………..…………………………………………………………………………….

      Emergency contact. (Name)………………………………………………………….

      Home Tele…………………………… Mobile ………………………………………

      Address ……………………………………………………………………………….

Photography.

Do we have your permission for your son/daughter to be photographed, so they may have a record of their achievements or for possible promotional purposes? YES / NO.

Can your child swim? Please tick where appropriate.

Declaration of consent.

I acknowledge the need for my child to behave responsibly during all activities, he/she will arrive wearing suitable clothing and I will ensure he/she will be collected or are able to make their own way home safely.

I have read, understand, and agree to all of the above.

Signed………………………………Print……………………..…Date…………….

PLEASE PRINT OFF FILL IN AND SEND BACK

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