Chipstead Place Lawn Tennis Club

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: __________________________________________

 

 

Signed			Date:
Name (please print)
Relationship to child
Address
Contact numbers:	Home
	Mobile
	Work
Email address

 

Further emergency contact details, if different from above:

 

Name (please print)
Relationship to child
Address
Contact numbers:	Home
	Mobile
	Work
Email address

 

 

Please use the box below to describe any special care needs, dietary requirements, allergies or medical conditions:

 

 

 

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:

 

Name (please print)
Address or instructions for returning form