Football Futures Consent Form – Football Futures Kent

Child's Full Name *

Date of Birth *

Parent/Guardian Name *

Parent/Guardian Contact Number *

Address *

Parent/Guardian Email *

Emergency Contact Name & Relationship To Child *

Emergency Contact Number *

Details of any known medical conditions/allergies and any medication being taken *

Any other requirements/directions that would be helpful for us to know *

Other persons authorised to collect the child *

Important Information *

I confirm I have read and agree to the following:

This information will be held in confidence. I will inform the coaches of any important changes to my child's health, medication or needs and to any changes in address or contact details. In the event of illness or accident, I give permission for first aid to be administered where considered necessary by a trained first aider, or for medical treatment to be administered by a suitably qualified medical professional. If my emergency contact cannot be reached and I should require emergency hospital treatment I authorise a coach to sign on my behalf of any written form of consent required. However, I understand that every effort will be made to contact my emergency contact as soon as possible. During the time you will spend with us, photographs/videos will be taken for general sport purposes and for this we need your permission. Upon signing this form, we will assume you have given permission for this unless otherwise informed. I confirm that the above details are correct to the best of my knowledge.

NAME PRINTED IN FULL

DATE

Phone