OWERMOIGNE F.C.
PARENTAL MEDICAL CONSENT FORM FOR
Players Name Date of Birth Address
Telephone No. Parents Name Next of Kin Emergency Contact No. Doctors Name & Contact No. NHS 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. Signature Print Name 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. Date
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.
IN CONFIDENCE