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Email *

JUNIOR MEDICAL AND PARENT CONSENT FORM

1. Name of the Junior member *

2a. Date of Birth *

2b. Is the junior member a British National? (required for Volleyball England Talent pathway or subsidies)? *

Yes

Required

3. Name of current school/ college: *

4a. Parent/ Carer's Name: *

4b. Relationship to the junior member: *

5a. Parent/ Carer's Mobile number: *

5b. Junior member's number if you would like us to keep it in the 2019-20 club register:

5c. Home number:

6. Please confirm Parent/ Carer's Email: *

7. Address: *

8. Emergency Contact Name: *

9. Emergency Contact Number: *

10. Member's medical information - any important medical conditions that the club should be aware of? (eg. epilepsy, asthma, diabetes...etc or None if not applicable): *

11. You give permission to use any still and / or moving images being video footage, photograph of the named junior member above for any of the following uses (please check all that applies) *

Video analysis for training and educational purposes

Cambridge Volleyball Club Website (eg. match / team pics)

Cambridge Volleyball Club Facebook/ Twitter/Instagram @cambridgeVC1 (eg. match / team pics)

Required

Comments:

Declaration

By submitting this form, you, the parent(s)/guardian(s) of the named junior member have read and understood the Cambridge Volleyball Club Code of Conduct and Young Person's Guide stated BELOW. In the event of an injury you give permission for the club to obtain emergency medical treatment.

You understand the changing facilities at training / match venues may be shared by other adult and junior members or members of the public; your child may change or shower at home should they be uncomfortable in using the facilities provided.

You also understand and hereby waive all claims for damages or loss to the named junior member and property as a result of accidents sustained with or in relation to Cambridge Volleyball Club, and the named junior member will comply with the section specified in "What does my club expect of me?"

Send me a copy of my responses.

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