Name of Parent / Carer *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of child *

First Name

Last Name

Are there any health needs (e.g. diabetes, asthma, epilepsy, allergies) that we should be aware of? *

Yes

No

Are there any dietary needs we should be aware of? *

Yes

No

Anything else we should be aware of? *

Yes

No

Name

First Name

Last Name

Address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

The team captain will inform you of the away match venue and what time players need to be there. Parents are responsible for transporting their children to and from away matches. They may choose to make private arrangements with another adult (for example, a relative, a family friend, other parents or a carer) to transport their child. In all such cases they are responsible for their own child’s safety and for the suitability of any travel arrangements. They must let the team captain and John Hall (Head Coach) know that they have made arrangements with another adult to take their child to and/or from the match venue. Please note that if such private arrangements do take place adults transporting children other than their own should seat them in the back of the vehicle. *

I am aware that I am responsible for transporting my child to and from away match venues or for making suitable arrangements as shown above.

Yes

Any photos or videos you take must be of your own child *

I am aware that any photographs or videos I take must only be of my own child.

Yes

I have fully read and understood this consent form *

Yes

No

Name *

First Name

Last Name

Date *

MM

DD

YYYY