Medical Information and Consent Form

EnglandAcademy

Medical Information and Consent Form

Medical Information

Name ______DOB______

Does your child have any conditions requiring medical treatment and/or medication? Yes/No

Please give details ______

______

______

______

Please outline any special dietary requirements of your child and the type of pain/flu relief medication your child may be given if necessary ______

______

______

______

Does your son/ward have any allergies? Yes/No

Please give details

______

______

______

When did your son/ward last have a tetanus injection? ______

Please give details of any illnesses or injuries your son/ward has had in the last 12 months

______

______

______

Emergency Contact______

Relationship to Child ______

Work Tel No: ______Work Mobile: ______

Home Tel No: ______Home mobile: ______

Home Address ______

______

Alternative Emergency Contact______

Relationship to Child ______

Work Tel No: ______Work Mobile:______

Home Tel No: ______Home mobile: ______

Home Address ______

______

Name of GP ______

Telephone number______

Address______

______

______

Medical Declaration

I will inform the necessary people as soon as possible of any important changes to my child’s health, medication or needs.

I will ensure that my son/ward has any medication they may need with them at training and games e.g. asthma inhalers/epipens. These should be given to the Coach/Team Manager prior to the start of training or game.

I, ______being parent/carer of the above named child,give permission for medical treatment to be administered where considered necessary by a nominated first aider, or bysuitably qualified medical practitioners.

It may be essential at some time for the Coach or Team Manager accompanying your child to have the necessary authority to obtain any urgent treatment which may be required whilst at representative competition or training. Please sign below if you wish to give your consent.

I, ______being parent/carer of the above named child, hereby give permission for the Coach or Team Manager to give the immediate necessary authority on my behalf for any medical or surgical treatment recommended by competent medical authorities, where it would be contrary to my son/daughter's interest, in the doctor's medical opinion, for any delay to be incurred by seeking my personal consent.

Parent/Carer

Signed______

Full name (capitals) ______

Date______

EnglandAcademy

Photographic and Recorded Images Uses Consent Form

The English Lacrosse Association (ELA) recognises the need to ensure the welfare and safety of all young people in Lacrosse. As part of that commitment we will not permit photographs, video’s or other images of young people to be taken or used without the consent of the parents/carers and the young person.

The ELA will follow the guidance for the use of images of young people, a copy of which is in English Lacrosse Child Protection Policy and Implementation Procedures.

The ELA will take all steps to ensure these images are used for the purposes they are intended, which is the promotion and celebration of the activities of the ELA.

If you become aware that these images are being used inappropriately you should inform the ELA immediately.

Childs Name ______

I, ______parent/carer of the above named child, consent/do not consent (please delete) to members of the ELA photographing or videoing my child, and to using suitable images on the ELA website.

______(name of child) understands the stated rules and conditions and confirm that they are legally entitled to give consent.

I also confirm that ______(name of child) is not subject to any legal restrictions regarding the taking or reproducing of their images.

Parent/Carer

Signed______

Full name (capitals) ______

Date______