LEICESTERSHIRE & RUTLAND HOCKEY ASSOCIATION

(MIXED SECTION)

PARENTAL CONSENT FORM (U18)

As your child is under 18 years of age, you are asked to complete the whole of the following form.

The LRHA provides coaching to players of mixed ages and abilities, in either a group situation or on a one-to-one basis. When required, the Management Team will arrange for transport to away matches, either by private vehicle or hired transport. Occasionally, a tournament will require overnight accommodation at a location arranged by the Management Team. Post-match hospitality is often arranged in clubhouses or public houses in the vicinity of the match location.

Hockey can be a hazardous sport – your child is encouraged to wear appropriate protective

Equipment at all times (e.g. shin guards, gum shield etc).

PART A: CHILD’S DETAILS

CHILDS NAME	ADDRESS	DOB	CONTACT INFORMATION
			Tel: Mobile: Other:

PART B: MEDICAL CONDITION

Please advise the LRHA of any medical condition that may affect the participation of your child in any

sporting activity undertaken whilst at an LRHA event (e.g. Asthma, Epilepsy).

ILLNESS

MEDICATION

PART C: PARENTAL PERMISSION

I understand all of the above and give permission for my son/daughter to attend events organised by

the LRHA. Furthermore, I give permission for the LRHA to seek medical attention for my son/daughter

if required.

Signed: …………………………………………………. Name: ………………………………………..

(Parent/Guardian)

Date: ………………………………