Baypoint Soccer Club Registration Form

Medical Information
Name of Local Surgery & Address
Name of Family Doctor

First NameLast Name
I authorise the club representative of the activities to give consent on my behalf for an anaesthetic to be administered on the advice of a medical practitioner.

I acknowledge and accept that Baypoint FC, or any other team manager or coaching assistant are not under any liability whatsoever in respect of personal injury, loss or damage to property that is caused whilst in attendance at training sessions or matches.

I set out below, or in an attached note, details of any medical conditions from which my son/daughter is suffering, together with details of any treatment and medications currently being taken.
Signature*

Clear
Name (BLOCK CAPITALS)*
Please declare any relevant Medical/SEND/Dietary Requirements/Cultural Requirements:*
Baypoint FC has a child protection policy procedure and a designated Child Welfare officer.

Parental/Guardian Consent
Photography

From time to time young people in their activities may be filmed (including video and photographic images) whilst taking part in activities. If you do NOT wish for your child to be included in any publicity materials please tick here
Data Protection

All information will be handled in a secure and confidential manner and held in accordance with the 1992 Data Protection Act. If you do NOT wish for your address to be retained on our database, please tick here
Waiver

I am fully aware that this sport activity may cause accidental injury to participants. I likewise assume any and all possible risk that may cause injury, illness, or death arising to such activity. I hereby declare that I waive my right to pursue any and all claims against Baypoint Club, in any case that the accident, injury, illness or death occurs in the course of any activity held by them.
Signature of Parent / Guardian*

Clear
Name

First NameLast Name
Date Signed

DayMonthYear
Date
Should be Empty:

Parent/Carer/Guardian Details