Consent Form | Kickabout FC

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Consent/Medical Questionnaire

Please fill out the following form to help us understand your childs physical condition.

Child's First Name

Your Email Address

Child's Last Name

Child's Date of Birth

Does your child have any relevant medical conditions?

Occasionally we photo-document/video sessions. Please indicate whether you are happy (yes) or not happy (no) for your childs image to appear in our publications and on our website. We will happily provide copies of any images/movie clips used. *

No

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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