Please complete the Tour Consent Form below in as much detail as possible.

EMERGENCY CONTACT DETAILS

Emergency Contact Person 1

Emergency Contact Person 2

DOCTOR'S DETAILS

MEDICAL AND ACTIVITY INFORMATION

| Does your child suffer from any medical condition / injury?

YES/NO
YesNo

| Are they currently on any medication?

YES/NO
YesNo

| Do You give permission for staff to administer medication?

YES/NO
YesNo

| Does your child have any allergies?

YES/NO
YesNo

| Does your child have any special Dietary requirements?

YES/NO
YesNo

| Are there any issues you feel we need to be aware of e.g. emotional issues such as family bereavement etc

YES/NO
YesNo

| I consent to my child receiving first aid medical treatment which in the opinion of a qualified practitioner may be necessary

YES/NO
YesNo

I consent to my child participating in other organised activities e.g. swimming, cinema, bowling etc.

YES/NO
YesNo

By completing this online form I confirm that I have read and understand the permission statements on this form and the privacy notice below.
YesNo

Signed (Parent/Guardian/Player over 18)

Signed

Privacy Notice. Lincolnshire Cricket will use the information provided on this form (together with other information it obtains about the player) (together “Information”) to administer his/ her cricketing activities in which he/she participates through Lincolnshire Cricket. To care for and supervise activities in which he/she is involved. In some cases, this may require Lincolnshire Cricket to disclose the Information to County Boards, Leagues and to the England and Wales Cricket Board. In the event of a medical issue or child protection issue arising, Lincolnshire Cricket may disclose certain information to doctors or other medical specialists. To the police, children’s social care, the Courts and or probation officers and, potentially to legal and other advisers involved in an investigation. As the person completing this form, you must ensure that each person whose information you include in this form knows what will happen to their information. For our full privacy policy click here

Form updated 2018.