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Basingstoke School of Development Centre Youth FC Contact Details, Covid-19 Self Screen Submission and Medical Consent Form
If you are human, leave this field blank.
Basingstoke School of Development Centre Youth FC Contact Details, Covid-19 Self Screen Submission and Medical Consent Form
Child's First Name
*
Child's Surname
*
Parent/Carers First Name:
*
Parent/Carers Surname:
*
Child Medical Conditions/Illness/Allergies (please put N/A if not applicable):
*
1st Emergency Contact Full Name
*
Contact Number
*
2nd Emergency Contact Full Name
*
Contact Number
*
Please Advise How Your Child Will Be Getting Home After Training Has Finished:
*
COVID-19 Self Screen Submission
*
Yes
No
I agree to complete and submit the COVID-19 Self Screen by 12 noon on the day of every training session for each of my children to participate along with completing a form for any adult/sibling attending as well. This is an FA requirement for track and trace purposes. Failure to complete and submit a form by 12 noon will mean your child will be unable to take part in that session date. As I’m sure you can understand and appreciate the administration involved to follow all procedures to keep everyone safe is huge and we need enough time to go through all replies hence the 12 noon deadline and we just don’t have the time nor resources to chase people to complete and submit forms. I agree that I will not send my children to training if they or anyone we live are displaying any signs or symptoms of COVID-19.
Consent 1
*
If my child has an accident, then they will be treated by a qualified first aider and I will be informed of the situation as soon as possible. If there is a situation where my child needs urgent medical treatment and I am unavailable I give permission for a member of staff from Basingstoke School Of Development Centre Youth FC to sign any consent forms necessary for treatment on my behalf, if the delay in getting my signature is considered by the doctor to endanger my child’s health and safety.
Yes
No
Consent 2
*
I give my permission and consent for my child to take part in contact football training sessions and matches for Basingstoke School Of Development Centre Youth FC for the duration of the year 2021
Yes
No
Consent 3
*
Basingstoke School Of Development Centre Youth requires parental consent before your child takes part in any football activities. By ticking this box you are agreeing to give consent for your child to take part in all Basingstoke School Of Development Centre Youth training sessions and matches, you are confirming that you have read and understood the activities being offered to your child and agree with the measures the club has put in place to manage any risks, including its Covid-19 measures in line with current Government guidance. A copy of the club’s risk assessment can be found via the following link: xxxxxxxx If your child has any specific medical conditions, please ensure that you discuss these with Matt Beckingham in advance and agree the best way to support your child’s needs e.g. you staying to watch nearby and taking responsibility to administer the medication. If your child has Covid-19 symptoms they must stay at home and follow Government advice. If you wish to withdraw consent to your child participating in any or all activities, please notify Matt Beckingham in advance, or as soon as possible.
Yes
No
My Child Attends The following Session (Please tick)
*
Monday
Tuesday
Friday
Date
*
Submit