Parental Consent Form

Are you registering a Child/Children or Youth (Under 18)?

Yes
No

The completion of this form is essential so as to enable your child participate in all GAA games, training and other activities in your Club.

I wish to inform that as a Parent/Guardian of my child/children, I give permission for the below named child/children to participate in training, games and other related activities with Laochra Óg Hurling Club.

Name*

First Last

Date of Birth*

Please state if your child has been diagnosed with any specific illnesses, condition, allergies or disabilities of which we should be aware (i.e. asthma, diabetes, epilepsy, or allergies to particular food or drink).*

Is your child currently taking any form of medication?*

Yes
No

Please give details:*

Can your child administer this medication without assistance?*

Yes
No

Second Child

+ Add Medical Details for a Second Child*

Yes
No

Name*

First Last

Date of Birth*

Please state if your child has been diagnosed with any specific illnesses, condition, allergies or disabilities of which we should be aware (i.e. asthma, diabetes, epilepsy, or allergies to particular food or drink).*

Is your child currently taking any form of medication?*

Yes
No

Please give details:*

Can your child administer this medication without assistance?*

Yes
No

Third Child

+Add Medical Details for a Third Child*

Yes
No

Name*

First Last

Date of Birth*

Please state if your child has been diagnosed with any specific illnesses, condition, allergies or disabilities of which we should be aware (i.e. asthma, diabetes, epilepsy, or allergies to particular food or drink).*

Does your child need to be in possession of or need to be able to administer medication while participating in GAA games or other activities?*

Yes
No

Please give details:*

Can your child administer this medication without assistance?*

Yes
No

Forth Child

+Add Medical Details for a Fourth Child*

Yes
No

Name*

First Last

Date of Birth*

Please state if your child has been diagnosed with any specific illnesses, condition, allergies or disabilities of which we should be aware (i.e. asthma, diabetes, epilepsy, or allergies to particular food or drink).*

Does your child need to be in possession of or need to be able to administer medication while participating in GAA games or other activities?*

Yes
No

Please give details:*

Fifth Child

Can your child administer this medication without assistance?*

Yes
No

+Add Medical Details for a Fifth Child*

Yes
No

Name*

First Last

Date of Birth*

Please state if your child has been diagnosed with any specific illnesses, condition, allergies or disabilities of which we should be aware (i.e. asthma, diabetes, epilepsy, or allergies to particular food or drink).*

Does your child need to be in possession of or need to be able to administer medication while participating in GAA games or other activities?*

Yes
No

Please give details:*

Can your child administer this medication without assistance?*

Yes
No

Sixth Child

+Add Medical Details for a Sixth Child*

Yes
No

Name*

First Last

Date of Birth*

Please state if your child has been diagnosed with any specific illnesses, condition, allergies or disabilities of which we should be aware (i.e. asthma, diabetes, epilepsy, or allergies to particular food or drink).*

Does your child need to be in possession of or need to be able to administer medication while participating in GAA games or other activities?*

Yes
No

Please give details:*

Can your child administer this medication without assistance?*

Yes
No

Below must be completed by a parent/guardian only

Parent/Guardians Name:*

First Last

Phone*

Phone (Second Number - Optional)

Email*

Accept*

Only accept if you are the Parent/Guardian of the above the named child/children and confirm that all of the above is true, complete and accurate.

Laochra Óg Hurling Club

It is required that you complete this form if you are registering a child, children or youth player

(Anyone Under 18 Yrs. old)

Parential Consent Form

Second Child

Third Child

Forth Child

Fifth Child

Sixth Child

Below must be completed by a parent/guardian only