Auto Cycle Union Guidelines - Child Protection Policy

Parent/guardian consent form

I, the parent / guardian * of:

…………………………………………………………………………………………………..

give permission to the medical personnel/staff/volunteers, meeting officials and official club photography / video participating in activities during any events to be run by

Lancashire Grass Track Junior Riders Club during 2008

for medical personnel/staff/volunteers to administer any relevant treatment or medication to the named participant, when/if necessary. I shall inform the organising club of any know conditions and medication requirements.

In addition, if the case arises, I authorise the members of medical personnel/staff/volunteers to take my son/daughter to hospital and give full permission for any treatment required to be carried out in accordance with hospital’s diagnosis. I understand that I shall be notified, as soon as possible, of the hospital visit and any treatment given by the hospital.

Parent / Guardian’s * consent

……………………………………………………………………………………..(signature)

Name……………………………………………………………………………(please print)

Relationship to participant………………………………………………………………….

*delete as applicable

29.12.07