S. Yorkshire 2023 Permission & Concent form

Name of Young Person Touring *

First

Last

Date of Birth *

Does the Young Person have any condition requiring special supervision, medical treatment and/or medication? *

Does the Young Person have any allergies? *

Does the Young Person have any specific dietary requirements? *

Does the Young Person have any other specific requirements (e.g. religious, cultural, etc.)? *

Will a parent/guardian be on tour as well (i.e. want to stay on-site)? *

All on site Adults will require an RFU DBS check through the Club

Please enter the nominated adult in charge of your child or children on tour *

First

Last

The RFU requires every child who is touring without a parent/guardian to have a nominated adult who is touring to be in charge of that young person and to make decisions on behalf of the parents, if the parents are uncontactable, in times of emergencies. The nominated person must agree to this.

Nominated Adults Phone Number *

Add others to the tour:

Yes, another Child

Emergency Contact Details

Declaration & Consent

General Declaration

• I agree to my son/daughter attending the proposed rugby tour • I consent to my son/daughter taking part in the activities indicated • I have ensured that he/she understands the importance of his complying with the rules and instructions given by the adults in charge • I accept that I may be required to bear the cost of any loss or damage that he/she causes. • I agree that photographs may/may not be taken of my son/daughter and if I agree to photographs being taken they can be used by WRFC. • I have received comprehensive details of the above tour and am aware of the RFU Policies and guidelines in relation to tours • I agree to be at the pick-up/drop off point at the agreed time • I agree that the information provided can be used for the sole purpose of delivering the tour and that it will be kept and processed in accordance with the Clubs Data Protection Policy . I understand that I have a right of access to the information, and that I have the right to withdraw my permission and my information at any time.

Consent

1. I confirm to the best of my knowledge that my son/daughter does not suffer from any medical condition other than those detailed. 2. I authorise a member of the Tour Management who holds a first aid qualification (or any other person equally qualified and authorized by the Tour Management) to administer emergency first aid treatment where this is necessary. 3. In the event of a serious illness or accident requiring medical treatment; (a). I agree to my son/daughter receiving treatment including surgical operation, anesthetic, or serum injection (except as detailed in "exceptions" below) as considered necessary by medical professionals; and (b). I agree to this treatment being authorised by a member of the Tour Management, who may sign any written form of consent required by hospital authorities, providing that the probable delay to obtain my signature is considered by a doctor, likely to endanger my son’s/daughter’s health or safety. 4. I understand that the Tour Management and voluntary helpers will take all reasonable care of my son/daughter but cannot necessarily be held responsible for any loss, damage or personal injury suffered by him/her.

Are there any medical consent exceptions? *

Name of Signatory *

First

Last

Relationship to Young Person or Persons on form *

Signature *

You can either draw your signature on a touch screen device, or use your mouse by holding down the left button and drawing it that way.

Todays Date *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country