MEDICAL CONSENT FORM
Date of Birth
Next of Kin
Emergency Contact No.
Doctors Name & Contact No.
I consent to my son receiving emergency medical treatment, which might involve the use of
anaesthetics and blood transfusions in the event of an accident or incident to him whilst involved
with Owermoigne F.C.
I understand that an official of Owermoigne F.C. will do their utmost to contact me prior to any
such treatment being administered.
If appropriate please provide any additional details regarding any illness or allergies they have
and any medications they are receiving, that may be of help in the event of an accident or injury.
Please continue on the reverse of this sheet if necessary.
This information will be treated in the strictest of confidence and will only be used in the event of
an emergency to your child. The Team Coach will keep it in the team’s first aid bag. Please return
it in a sealed envelope with the name of your son on the front and your signature across the seal
on the reverse.