SUSSEX SPRINGERS Membership form 2008 ! FULL NAME DATE OF BIRTH HOME ADDRESS TELEPHONE NO. E MAIL ADDRESS EMERGENCY CONTACT NOS. & RELATIONSHIP TO PARTICIPANT 1) 2) DOCTOR’S NAME & TELEPHONE NO. SCHOOL ATTENDED BRITISH GYMNASTICS MEMBERSHIP NUMBER & CLUB (IF REGISTERED) DETAILS OF ANY MEDICAL CONDITIONS DETAILS OF ANY MEDICATION BEING TAKEN REGULARLY ANY OTHER INFORMATION WHICH MAY BE HELPFUL (Allergies etc) I CONSENT TO MY CHILD/CHILDREN GOING HOME UNACCOMPANIED (if under 16) !Yes No I consent to any emergency medical treatment necessary during training sessions. I authorise the staff to sign any written form of consent required by the hospital authorities if the delay in getting my signature is considered by the Doctor to endanger the participant’s health and safety !Yes No PARENT/GUARDIAN’S SIGNATURE DATE ! For Club Use Only Start Date Treasurer Sessions Competition Secretary Grade Membership Secretary Membership Form 2008
© Copyright 2024 ExpyDoc
![平成27年度 同意書（日英）[PDF：118KB]](http://s3.expydoc.com/store/data/007540930_1-ee536cbc263c62a3b2a6b1254c329acf-250x500.png)
