DARLINGTON F C
in association with
DARLINGTON FC
SUPPORTERS CLUB
CONSENT FORM Under 16's
Anyone under the age of 16 must complete one of the below forms before travelling with the Supporters Club on the away match coaches.
Please complete this form as fully as possible. The completing of this form will not only consent the minor stated below to travel on the Supporters' Club Away Supporters' coaches to away games but also provide essential information in the event of an emergency.
Darlington Football Club's visit to:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Leaving Darlington: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Arriving Back: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
NAME OF MINOR: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Home Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Post Code: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Telephone Number(s): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I hereby consent to the participation of my son/daughter to travel with Darlington F.C. Supporter's Club Away Supporters. I acknowledge the need for obedience and responsible behaviour on his/her part whilst in your care.
MEDICAL INFORMATION
- Does your son/daughter suffer from any conditions requiring medical treatment?
Please Specify:
If YES - please give brief details and describe any medication, dosage and frequency required/taken:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I further consent to the giving of such urgent medical or surgical treatment, including anaesthetic to my son/daughter, as considered necessary by the medical authorities as a result of an emergency during our trip.
- Is your son/daughter allergic to any medication?
Please Specify:
If YES - please give brief details:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
- Has your son/daughter received a tetanus injection in the last five years?
Please Specify:
DECLARATION
Sign to acknowledge your agreement and consent.
If you have any reservations or queries in connection with the trip please contact DFC Supporters' Club Tel: 01325 243911.
In consideration of the person in charge of this trip agreeing to the inclusion of my son/daughter as a member of the trip, I hereby undertake to indemnify him/her and any other member of the visit against any unreasonable expense incurred on behalf of my son/daughter during the visit.
Signed: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Parent/Guardian Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
In the event of unsuitable behaviour by your son/daughter whilst in our care, we will contact you to discuss the details with you and also ban your child from future visits on Supporters' Club coaches.
ON COMPLETION OF THIS FORM PLEASE RETURN TO DFC SUPPORTERS' CLUB BEFORE THE JOURNEY
Please hand in at the Supporters' Club table in the Tin Shed Bar or hand to the person in charge when boarding the coach.
