School Club Membership Form

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Please complete the following details of your Family Doctor

Parent/Carer

DECLARATION OF PARENTS/CARERS

a. I agree to my son/daughter taking part in club sessions

b. I consent to any emergency medical treatment necessary during the sessions. I therefore authorise the supervisor to sign any written form of consent required by hospital authorities on my behalf, should the delay required to obtain my signature be considered likely to endanger my child’s health by the said authority. In such circumstances I understand that every effort shall be made to contact me prior to this action being taken.

c. I understand that the sessions are insured in respect of legal liabilities (third party and public liability) but that personal accident insurance for my child is not covered. I also understand that any extension of insurance for my child is my responsibility.

d. I will ensure that any changes in circumstances, which will effect my child’s participation in the sessions, will be notified to name on telephone number as soon as possible prior to the event.

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