AES/UNSS SPORT CONTACT DETAILS & MEDICAL INFORMATION

2014-15
Dear Parents and Guardians,
In order to have all relevant information on your child, please fill out and return this form to Katia
LY-WA-HOI A!ti"iti#$ C%%&'i(at%& before joining the activity. While we put in place all possible
safety measures, at times accidents do occur in sport. In these situations we need to be able to act
quicly and with parent support.
PARENTS EMAIL ADDRESS )
NE*T POINT OF CONTACT + FOR ANY REASON IF ,OTH PARENTS CANNOT ,E CONTACTED
PLEASE INDICATE THE DIRECT NE*T POINT OF CONTACT
NAME)
RELATIONSHIP)
CONTACT NUM,ERS)
CARE AND HOSPITALISATION-S AUTHORISATION
I THE UNDERSI.NED /NAME AND SURNAME0 111111111111111111111111111111111 AUTHORISE
MY CHILD 11111111111111111111111111111111 TO RECEI2E FIRST AID IN CASE OF EMER.ENCY
AND TO ,E TAKEN IN CHAR.E ,Y THE EMER.ENCY SER2ICE /3330 TO ,E MANDATORILY REFERRED
TO THE PU,LIC HOSPITAL
SI.NED DATE
T4# $5%&t$ 67 !4i8' i$ 5a&ti!i5ati(9 i( :%& FIS a&#) /58#a$# 8i$t0
STUDENT NAME CLASS
CURRENT MEDICAL ISSUES OR MEDICATION
CONTACT NUM,ERS IN CASE OF EMER.ENCY
HOME OFFICE MO,ILE
MOTHER
FATHER
.UARDIAN