Pathway Club Consent Form Child's Full Name: * Full Address: * Postcode: * Date of Birth: * MM DD YYYY Age: * (Home) Phone Number to contact in an emergency: * (Work) Phone Number to contact in an emergency: * (Mobile) Phone Number to contact in an emergency: * If unavailable, alternative emergency contact person's name: * Alternative emergency contact person's phone number: * Relationship to child: * Name of Child/Young person's GP: * GP's Surgery: * GP's Tel no: * Details of known conditions - allergies, asthma, diabetes, epilepsy etc and any medication being taken: * Any other special needs, requirement or information that would be useful to leaders to know about: * I agree to the following: I will inform the leaders of any important changes to the details above. In the event of illness or accident, having parental responsibility for the above named child, I give permission for First Aid to be administered where necessary, or for medical treatment to be administered by a suitable qualified medical practitioner If I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital. However, I understand that every effort will be made to contact me as soon as possible. I CONFIRM THAT ALL THE ABOVE DETAILS ARE CORRECT TO THE BEST OF MY KNOWLEDGE * Parent/Guardian Name Printed In Full: Date Signed: MM DD YYYY Thank you!
