Chipstead Place Lawn Tennis Club
CPF 3.1.10 - Trip and activity consent form
I do/do not (please delete as appropriate) give permission for my child:
_______________________________________________________ (child’s full name)
to attend the following trip/activity: __________________________________________
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Signed
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Date: |
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Name (please print)
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Relationship to child |
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Address |
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Contact numbers:
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Home
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Mobile
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Work |
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Email address
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Further emergency contact details, if different from above:
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Name (please print)
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Relationship to child |
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Address |
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Contact numbers:
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Home
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Mobile
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Work |
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Email address |
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Please use the box below to describe any special care needs, dietary requirements, allergies or medical conditions:
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In the event of a medical emergency, I give my consent for the group leaders to seek qualified medical assistance at their discretion and for them to give permission for emergency medical treatment / procedures to be administered/carried out if so advised by the emergency services or medical profession in the interests of the safety and protection of your child.
Signed: ____________________________________________________________________
Parent/Guardian: _____________________________________________________________
Relationship to child: ___________________________________________________________
Please return this form to:
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Name (please print) |
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Address or instructions for returning form
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