Parental/Guardians Consent Form

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North Down Cycling Club

 Parental/Guardians Consent Form

Anything written on this form will be held in confidence. Our coaches and leaders need to know these details in order to meet the specific needs of your child.

Child’s Full Name:                                                                                      Male/Female


Date of Birth:

Home Tel No:

Emergency Contact No:    1.

Emergency Contact No:    2.

Doctor’s Name:

Doctor’s Tel No:

Medical History Information (details of any known allergies, conditions, medications, special needs etc.)



In the event of illness/injury, having parental responsibility, I give permission for medical treatment to be administered where considered necessary by a nominated first aider or by suitably qualified medical practitioners. If I cannot be contacted and my child needs emergency medical or surgical treatment, I authorise a qualified medical practitioner to provide emergency treatment or medication. In all instances I understand that the Club will do all it can to contact me as soon as possible.

I have been made aware that North Down CC has a Safeguarding Young People and Vulnerable Adults Policy which is in line with that of Cycling Ulster’s policy for the Safeguarding of Young People and that they are committed to ensuring the safety of my child.

I understand that photographs may be taken during or at cycling related events and may be used in the promotion of cycling or training/coaching purposes.

I will inform NDCC’s Safeguarding Officer of any important changes to my child’s health, medication or needs and also of any changes to our address or phone numbers given.

I confirm that all details are correct and I am able to give parental consent for my child to participate in and travel to all cycling activities.

Signature of Child                 __________________________________

Signature of Parent/Guardian__________________________________

Print name                             __________________________________

Date                                       __________________________________

Please return this form to the relevant Coach/Leader or to the Club Secretary.

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