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

Data protection. 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 activity at the Club and in any activities in which he participates through the Lincolnshire Cricket and to care for and supervise activities in which he/she is involved. In some cases this may require the 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, the Lincolnshire Cricket may disclose certain information to doctors or other medical specialists and/or to 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.

Form updated 2018