Clubs Consent and Medical Form

Clubs Consent and Medical Form

I give permission for my child. Please state your child's full name below (first and last name) *

Child's form: *

Emergency Contact Name: *

Emergency Contact Number: *

Should the necessity arise, I agree to the person in charge of the visit giving consent on my behalf for an anaesthetic to be administered or for any other urgent medical treatment to be given. *YesNo

I understand that if I require personal insurance for my child I must make separate arrangements. Please fill in the next question with any details of present medical conditions/medications including asthma and allergies.YesNo

Please explain any present medical conditions/medications including asthma and allergies: *

If none, please state N/A

I give permission for my child to be photographed: *YesNo

behalf your understand

I give permission for my child's photo to be placed across Knole Academy's social media channels: *YesNo

Date: *

Submit