Please hand this signed consent form over to the sports instructor before taking part in any of the activities.

I give consent for _______________________ to take part in the activities offered by SNAP PLAY.

Signature of parent/guardian:__________________ Date: __________

Address: ___________________________________________________________

Home tel no.:                                                     Work tel: no.:

Mobile tel no.:

EMERGENCIES:

Name of person to contact in an emergency:_____________________________________________

Relation to young person:__________________________________________________________

Tel no.: ______________________________________________________________________

Address (if different from above):

___________________________________________________________________________

I give consent for my child to receive emergency medical treatment if required:

Signed:_________________________________ Date: ___________________

Print name:______________________________________________________

PHOTOGRAPHS & VIDEOS: During SNAP Play activities photographs and short videos may be taken. SNAP Play may use these for publicity purposes. Please delete accordingly.

I give / I do not give SNAP Play permission to use photographs of the child/young person in my care for publicity purposes. Signed: _________________________ (parent/guardian)

MEDICAL INFORMATION: Please list any of the participant’s medical information that we should be aware of:

Allergies (e.g. asthma, penicillin): _____________________________________

Regular medication (e.g. inhaler): _____________________________________

Other (e.g. epilepsy): ______________________________________________

Signed:_________________________________ Date: ___________________

Print name:______________________________________________________

SELF-REGISTRATION & RELEASE CONSENT: I give permission for my child to register and release him/herself at the start and end of each session.

Signed:_________________________________ Date: ___________________

COLLECTION BY THIRD PARTY: I give permission for my child to be collected by (print name of third party):________________________________________________________

Signed:_________________________________ Date: ___________________