CONSENT & MEDICAL FORM

To ensure the club has the correct medical information to inform the environment for your young person, please complete this Medical and Consent form.

Young Person's info:

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

Does your young person take any medication that Gateshead East Judo Club should be aware of?

Does your young person have any medical conditions that Gateshead East Judo Club should be aware of?

Has your young person become dizzy / fainted whilst exercising?

Has your young person ever had heart problems?

Has your young person ever had a head injury?

Does your young person have any allergies?

Does your young person cough often / become breathless during exercise?

If you answered yes to any of the above please give details here...

Parent / Carer Name:

First Name

Last Name

Parent / Carer Email

Are you the responsible parent / carer / adult for this young person?

Yes

If your answer to the above is 'No', please tell us more about why you're completing this form for the young person.

Parent / Carer Phone number

(###)

###

####

Parent / Carer Address (If different from young person)?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

British Judo Membership Info:

Licence Number

Expiry Date

Type of Licence

The parent /guardian on behalf of the young person I hereby consent to my young person receiving medical treatment that may be deemed advisable by Gateshead East Judo Club in the event of an injury / accident or illness while practicing in Judo including, but not limited to, transportation of the young person to hospital or walk-in centre.

Typing your name as parent / carer is your sign of consent here:

Line

Media Consent

We love capturing the awesome Judo at our club. With your permission, we might use photos and videos that contain your young person participating in activities for: + Our website and social media pages (e.g., Facebook, Instagram) + Club newsletters and promotional materials + Local newspaper articles or British Judo association publications Your Choice:

Yes - I'm happy for my young person to be included! I understand that I can withdraw my consent at any time by contacting [Name/Email/Phone number].

No - No, please don't include my young person in photos or videos.

Additional Information: We will never share your images or videos with anyone outside of the Judo club without your explicit permission. You can always request to have specific images or videos removed by contacting [Name/Email/Phone number]. For more information about how we handle your data, please see our Privacy Policy [link below].

You can find our Privacy Policy here.

CONSENT & MEDICAL FORM

CONSENT & MEDICAL FORM

LINKS

CONTACT

GATESHEAD EAST JUDO CLUB