For each registered player
under 18, the Berks & Bucks FA require a parent or guardian to provide the
information below and to sign the declaration. Please return the completed form
to your child’s team manager.
Player’s name: .
Address: .
.
Date of Birth: Home Telephone: .
Parent/Guardian’s name: .
Child’s doctor: Telephone: .
Provide details of any medication, ailments, allergies or other information that we should be aware of in case of an emergency. Also please make us aware of any changes:
.
.
.
.
Note that the club carries Public Liability insurance on behalf of all the players, managers and other club officials. However the club does not have personal accident insurance; should you wish to consider having this cover for your child, details of suitable policies are available from local schools.
Declaration:
·
I agree to my child taking part in matches, training and other
activities organised by Woodley Saints FC.
·
I agree to my child receiving medication as instructed, and any
emergency dental, medical or surgical treatment, including anaesthetic or blood
transfusion, as considered necessary by the medical authorities present.
·
I have read and understood the above notes, and the information I have
given is complete and correct to the best of my knowledge.
Signed: Dated: .