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Parental Consent Form Template 01

This document is a parental consent form for a child to participate in the tennis activities of Anyclub Tennis Club. It requires the parent to provide their name and contact information, consent for their child to participate in club activities according to the club's code of ethics and child protection policy, and acknowledge that the club is not responsible for adult supervision except as outlined in the policy. It also requests medical details and consent for any photographs or videos of the child.

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shiela manalaysay
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1K views2 pages

Parental Consent Form Template 01

This document is a parental consent form for a child to participate in the tennis activities of Anyclub Tennis Club. It requires the parent to provide their name and contact information, consent for their child to participate in club activities according to the club's code of ethics and child protection policy, and acknowledge that the club is not responsible for adult supervision except as outlined in the policy. It also requests medical details and consent for any photographs or videos of the child.

Uploaded by

shiela manalaysay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Anyclub Tennis Club

Form 3 - Parental Consent Form (Appendix 10)

I confirm that I ________________________________ am the parent/legal guardian of

___________________________________________.

I hereby consent to the above child participating in the tennis activities of Anyclub Tennis Club in
line with the Code of Ethics & Good Practice for Children’s Sport. I have provided contact details
below and undertake to inform the Hon. Sec. of the club of any changes to this information. I
confirm that all details are correct and I am able to give parental consent for my child to
participate in all tennis activities in the club.

I confirm that I have read Appendix 11 of the club’s Child Protection Policy and undertake to
abide by the obligations which it imposes on me as the parent/legal guardian of the above-
named child.

I acknowledge that the club is not responsible for providing adult supervision for my child except
as set out in Appendix 11 of the club’s Child Protection Policy.

Name:(please print)_________________________________________

Signature _____________________________________

Contact Details

Name of Child__________________________________________

Address_______________________________________________

_______________________________________________

Parent’s Mobile Phone No. ________________________________

Emergency Contact No. (1)________________________________

Emergency Contact No. (2) ________________________________


Please also include all medical details that might be relevant in dealing in with your child
in a safe manner, such as allergies, medication, special needs, etc.

____________________________________________________________________________

Photographic & Video Consent

I consent/do not consent to the below mentioned child being included in any photographic or
video material, in any publications/websites/social network applications which may be used for
the purpose of documenting and highlighting their involvement in tennis.

Name: ___________________________________________

Age: ________

Signature: _________________________________________

Date: _______________

Print Name: ________________________________________

State Relationship to child: ____________________________

Phone No. _________________

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