Aldenham FC Excel
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Medical Consent Form
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Parent's Name
*
First
Last
Emergency telephone number
*
Child's number Emergency
Mobile number
*
Email
*
Child's name
*
First
Last
Child's date of birth
*
2nd Emergency name
*
First
Last
2nd Emergency contact number
*
Please list Medical conditions below:
*
Parental Consent:
*
Yes
No
In the event that my son, daughter is injured whilst playing football/travelling to and from football evenets and I cannot be contacted on the above number, I hereby give my consent for my child to receive medical attention.
Submit