Surname ________________________________________

Fornames _______________________________________

Address_________________________________________

_______________________________________________

Post Code _______________________________________

Date of Birth ____________________________________

Home Telephone Number ____________________________

Please list below additional contacts and telephone numbers which may be used in an emergency:

1.

2.

3.

The Blue and White Skippers have a team kit and tracksuit which MUST be worn for competitions, displays and workshops. Your Son/Daughter will be expected to purchase this kit from the merchandiser if they prove successful to travel with the team.

Consent Form

Name ______________________________________

Name and Address of Parent/Guardian ____________

___________________________________________

Telephone Number ____________________________

Emergency contact and telephone number ___________

Any medical conditions we need to be aware of ______

____________________________________________

Name and address of Doctor _____________________

_____________________________________________

Your authority to administer emergency treatment by a first aider/doctor/hospital in the absence of Parent/Guardian

PARENT/GUARDIAN SIGNATURE ___________________

_______________________________________________

DATE __________________________________________