Parental Consent for Football

Football Club / Team / Class Name:

Details of Participation

The Child will be undertaking: From: Date / Time: / To: Date / Time: /

I agree to ________ (name) participating in the aforementioned activity and I acknowledge the necessity for ________ (name) to behave in a responsible and acceptable manner.

______________ (name) will travel to and from training / matches / the class in the following manner (unless otherwise informed by myself). To: From:

Medical Information

Are there any medical conditions that may affect or interfere with ____________ (name) participation with the aforementioned activity? Yes / No If yes, please provide further details:

Please could you provide further information on any additional factors (medical, behavioural or dietary) that may lead the necessity of alternative requirements or arrangements?

I understand that it is my responsibility to ensure that all the above details are accurate and kept up-to-date should any of them change.

Signed:

Print:

Date: