LRFC - Team - Parental Consent Form Season 2011/12
Please complete this form with details of your child.

All information provided will be treated as confidential and is for our information only.
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Name of Child *
Team Name *
e.g. Panthers U12's
Childs Date of Birth *
Please answer in dd/mm/yyyy format
School Attended
Current School Year
As at September 2011
Does your child have any medical conditions that we should be aware of? *
Please note that this information will be treated as confidential and is for our information only.
Name of Parent / Guardian
Parent / Guardian Contact Number
Please provide the number that we can reach you on in the event of an emergency
Parent / Guardian Email Address
Submit
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