Easter /Summer 2018

saddlertennis.com TENNIS CAMP REGISTRATION FORM

To be completed by the parent or guardian of the participating child.

CHILD’S NAME : …………………………….. D.O.B………. MALE/FEMALE SCHOOL: ……………

ADDRESS : …………………………………………………………POSTCODE………………………

PHONE : (Home) …………………………………..(Mob)………………………………

EMAIL:……………………….@……………………………

EMERGENCY CONTACT: (NAME 1)…………………… (NAME 2)……………………………

MOBILE NUMBER (1st)………………………… (2nd)……………………………

RELATIONSHIP ……………………………… ……………………………

Does your child now have or has your child ever had a history of or experienced the following :

DiabetesYes / Noexplain………………………………………

AsthmaYes / NoDo they use a preventer [Y/N] and/or relaxer [Y/N] ?

Other respiratory problemsYes / Noexplain………………………………………

HeadachesYes / Noexplain………………………………………

DizzinessYes / Noexplain………………………………………

EpilepsyYes / Noexplain………………………………………

Other type of seizureYes / Noexplain………………………………………

Difficulty withexercise/co-ordinationYes / Noexplain………………………………………

Any disabilityYes / Noexplain………………………………………

Allergy to….penicillinYes / Noexplain………………………………………

….nutsYes / Noexplain………………………………………

….bee/wasp stingsYes / Noexplain………………………………………

DispraxiaYes / Noexplain………………………………………

Attention Deficit DisorderYes / Noexplain………………………………………

Behavioural ProblemsYes / Noexplain………………………………………

Any other ‘Special Needs’Yes / Noexplain………………………………………

Please indicate here any other allergy or medical condition of which we should be aware

…………………………………………………………………………………………………………………………

Currently taking medication ?Yes / Noexplain……………………………………………………….

Are there any medical reasons why your child[ren] should not take part in energetic activity?Yes / No

If yes, please explain …………………………………………………………………………

Do you give permissionfor us to:

  • administerfirst aid to your child? Yes / No
  • callEmergency Services to attend to any ill health / injury sustained by your child? Yes/ No

Do you give permission for us to take & use photos & digital images of your child[ren] during tennis camp activities for

eg club noticeboard, website, coaching brochure ? Yes / No [WE WILL NOT POST on social media eg Facebook, Twitter]

I, the parent / guardian of the aforementioned child[ren], acknowledge the above information to be true and accurate.

To the best of my knowledge, I have given all relevant information regarding my child’s health and ability (including a good behavioural attitude to all the other children and tennis camp staff) to participate safely and fully in their saddlertennis session(s).

Signed : ……………………………………………. Date :………………………………