CHILDREN IN TAEKWONDO

PARENTAL CONSENT FORM FOR EMERGENCY

MEDICAL TREATMENT

PARENTAL CONSENT FORM FOR EMERGENCY FIRST AID / MEDICAL TREATMENT

Should your child suffer an injury or become ill whilst practising taekwondo, it may not always be possible to contact you. Please complete and return the authorization if you agree that your child is provided first aid and/or given emergency treatment should you not be available to give your consent at the time. The data in this form will be processed solely for the said purposes and will remain strictly confidential in line with the Data Protection Act.

Name of Child: …………………………….……………………………………………………

Date of Birth: ……………………………….…….……………………… Age: ………………

Gender: Male Female

Address: ……………………………………………………………………………………........

……………………………………………….………… Postcode: ……………………………

Child’s Doctor’s Name: ……………….………………………………………………………...

Mobile telephone: …………………………... Clinic telephone: ……...………………………..

My child suffers from the following allergies / conditions:

Fits or Blackouts

Please record below other medical conditions, allergies or any medication prescribed for your child:

Record medication that you know SHOULD NOT to be administered:

* My child is under 16 years of age.

I hereby authorise for my child to receive essential medical treatment from a qualified medical practitioner at a hospital or other medical centre, where necessary.

*My child is 16 years of age or over.

I acknowledge that he / she has the right to decide for himself / herself on the treatment to be received or the need to attend hospital or medical centre.

In the event of any medical attention being administered, I understand that I will be informed of the action taken.

Signed - Parent/Guardian:

Print name: Date:

*Deleteasnecessary