Pyramid Rock Holiday Club Consent Form (Online)

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CONSENT

Please use a separate form for each child

Please make sure that you complete both a Registration and Consent Form

 

I confirm that the details given are complete and correct to the best of my knowledge.

In the unlikely event of illness or accident, I give permission for any appropriate first aid to be given by the nominated first-aider.

In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment, including anaesthetic if necessary.  I understand that every effort will be made to contact me as soon as possible.  Please sign and date the form where indicated

 


I give permission for my child's photograph to be :*
Yes
No
Child's Full Name :*
Child's Address:*
Emergency Contact Name:*
Telephone:*
GP's Name:*
GP's Address and Telephone Number:*
Any known allergies or conditions:
Signature of Parent/Guardian:*
Date:
Please enter the verification number on the right:*
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* Required Fields

Pyramid Rock Consent Form
Webpage icon Pyramid Rock Consent Form (Printable Version)