Parental Consent Form
Parental consent is required for individuals under the age of 18 years participating
in any activity at the Nene White Water Centre. These activities are by their very
nature, ‘Risk Assumed Sports’. In signing this consent form, the parent / guardian
agrees to allow the child specied below to participate in the activity with full
acknowledgement of those risks.
General Information
Child’s Full Name: Date of birth:
Address: Post Code:
Email: Telephone:
Medical Information
Does your Child have any medical conditions?
for example asthma, diabetes, epilepsy etc
Please give details:
Yes No
Are there any medicines your child is currently taking?
Please give details:
Yes No
Does your child have any special requirements?
Please give details:
Yes No
Parent / Guardian Telephone Contact Details (ignore this section if you are remaining on-site)
During the session / course, my telephone number will be:
Alternative telephone number:
Parent / Guardian Signature
I the legal parent/guardian of .......................................................................give consent for my child to take part in this activity.
In the event of an incident or accident involving my child, I agree to my child receiving rst aid from a suitably qualied person and/or
any medical or dental treatment, including but not without limitation to anaesthetic and blood transfusion which may be considered
necessary by a registered medical practitioner.
I also agree to any photos/videos taken of my child to be used for publicity purposes. (Initial ................... to opt out).
Name: Date: Signature:
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Email: info@northamptonactive.com
