Parental Permission Form

Participation in Czech Cricket matches by under 18’s is subject to the requirements and restrictions as set out in the Junior Playing Conditions.
This form must be returned to the league Administrator prior to anyone under the age of Eighteen (18) participating in open age league cricket in the Czech Republic.

leagueadministrator@czechcricket.cz

Name *

Your answer

Address *

Your answer

Date of Birth *

YYYY

Parent's/Guardian's name

Your answer

Parent's/Guardian's Contact number *

Your answer

Parent's/Guardian's email address *

Your answer

Name of alternative adult who can be contacted in an emergency *

Your answer

Alternative adults relationship to child *

Your answer

Alternative adult's contact number *

Your answer

Any specific medical conditions requiring medication *

Yes

If yes please give details

Your answer

Any specific medical conditions or disability?

Your answer

Any allergies?

Your answer

Any dietary requirements?

Your answer

Consent information *

I give my consent that if an emergency medical situation arises, the organisation/club may act as loco parentis. If the need arises for administration of first aid and/or other medical treatment which in the opinion of a qualified medical practitioner may be necessary. I also understand that in such circumstances that all reasonable steps are made.

I confirm that I have read, or been made aware of, the junior playing conditions

Required

YYYY

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