Ombersley Club Shop

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Player Details

Child First Name

Child Last Name

Child D.O.B

Day

Month

Year

Medical Information (Including Allergan Information)

Primary Emergency Contact

Parents/Guardian Name (Main Emergency Contact)

Parents/Guardian Number (Main Emergency Contact)

Address

Relationship To Player

Secondary Emergency Contact

Secondary Emergency Contact Name

Secondary Emergency Contact Number

Address

Relationship To Player

Further Details

I give permission for my child to take part in this residential trip and confirm that I have read the parent information pack and the player safeguarding and supervision policy and give informed consent (See Below)

I give permission to be added to a whatsapp group for the trip duration

Photo Consent

Parents Full Name

Signature

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Parents Information Pack

Player Safeguarding & Supervision Policy

info@encompasscoaching.co.uk

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Player Details

Primary Emergency Contact

Secondary Emergency Contact

Further Details