Lasswade Athletics Club

Parental Consent Form

Completion of this form allows the named athlete to travel and compete for Lasswade Athletics Club covering Summer Track & Field, Winter Cross Country & the Winter Indoor League season.

CHILD'S DETAILS:-

First Names (Please Print)

Surname (Please Print) D.O.B

Address

(Please Print)

Post Code

Please detail any relevant Medical Information of which Lasswade Athletics Club’s Coaches/Team Managers should be aware.

(Please Print)

Emergency Contact Name: - Emergency Contact No:-

In case of Emergency Only:-

Doctor's Name:-

Doctor's Telephone No:-

I here by give my permission for my child to travel & compete with and for Lasswade Athletics Club

Parent/Guardian Name (Please Print)

Signature

Contact Tel No’s:-

Day Evening Mobile No:-

Completed Forms to be sent to:- John Brash[LAC Membership Secretary ]

Chairman: Brian Wilson Secretary: Norrie Kristoffersen Treasurer: Barbara Howie Welfare Officer: Alison Chalmers Membership Secretary: John Brash Tel No 0131-621-0188 Mob No 07793862518 Email: johnbrash1@hotmail.com

Please Return completed form to address below/ or at any training nightJohn Brash95 Gilmerton Dykes CrescentEdinburgh. EH17 8JW

Chairman: Brian Wilson Secretary: Norrie Kristoffersen Treasurer: Barbara Howie Welfare Officer: Alison Chalmers Membership Secretary: John Brash Tel No 0131-621-0188 Mob No 07793862518 Email: johnbrash1@hotmail.com