SOUTH HOBART FOOTBALL CLUB
Playing the world game since 1910
PO Box 174
SOUTH HOBART TAS 7004
W: www.southhobartfc.com І E: [email protected]
Consent and Medical Form – Holiday Football Clinics
Select which days your child is attending:
19 April
20 April
21 April
Location
Wellesley Park
Description
April 2016 Holiday Football Clinics (from 9:30am to 2:00pm)
Head Coach
Ken Morton
Clinic Run By
South Hobart Football Club in partnership with our player development partner
Morton’s Soccer School Pty Ltd
Personal details
Child’s name
Medicare Number
Private Health Insurance Details
Home address
Date of birth
Any Allergies? NO – YES (details)
Any Medical Conditions? NO – YES (details)
Emergency contacts
Name
Relationship
Phone (mobile)
Phone (day time)
1.
2.
Doctor
Phone
Address
CONSENT
Participation
I consent to my child’s participation in this football clinic. My child is capable of participating
in this type of clinic without any special assistance. I have told the Head Coach or
Administrator Victoria Morton about any issues my child might have.
Good Behaviour Required
I understand that for my child to participate in this football clinic my child must be on their
best behaviour, be respectful to all others and try their best. I will immediately come and
collect my child if I am contacted because my child’s behaviour is deemed by the Head
Coach to be inappropriate. I will not seek any refund in these circumstances.
Risk of Injury
I understand that participation in this football clinic involves some risk of injury for my child. I
will not pursue legal action against any of the Club, Morton’s Soccer School P/L or the Head
Coach in the event my child is injured.
Medical
In the event of injury, accident or illness when it is impracticable or impossible to
communicate with me, I understand that the Club or Morton’s Soccer School staff will
arrange such medical or surgical treatment as may be deemed necessary.
Expenses
I agree to promptly reimburse the Club or Morton’s Soccer School for any:
1. hospital, medical or ambulance expenses incurred by the Club on behalf of my child;
and/or
2. wanton damage caused by my child.
Signature of Parent/Guardian: ……………………………………………………………………………….
Name of Parent/Guardian: ……… .........................................................................................................
Date: ...........................................................................................................................................................
Personal Information Protection Statement
Personal information will be collected from you for the purpose of obtaining player details and will be used by the Club for
managing the clinic and for advertising future clinics. Failure to provide this information may result in your child being unable to
attend the clinic. Personal information will be used for the primary purpose for which it is collected and may be disclosed to
health care and emergency services in the case of an emergency. The information collected will otherwise remain confidential.