MSJ Coaching | Consent Form

Chosen Session*

Date:*

Time

Venue:*

Have you paid?

Yes
No

Childs Name*

Child's Age:*

Parents Name*

Mobile Number*

Alternative parent/guardian

Alternative Mobile Number

Email address*

Happy to receive info about MSJ Coaching?

Yes
No

COVID 19 - Please confirm that the individual does not have any COVID 19 Symptoms at present and should any develop prior to the session and within 5 days contagious period or if positive lateral flows are presented you will notify MSJ Coaching or the relevant coach at your earliest opportunity and accept that the session would need to be rescheduled if possible

Does Not Have Symptoms
Does Have Symptoms

Disability or medical Information*

(Asthma, allergies, impairments) I will ensure any further condition which develop prior will be updated with the Coach prior to the start of the session.

Medical History (if applicable)*

I will ensure any further condition which develop prior will be updated with the Coach prior to the start of the session.

Under the RFU Headcase campaign or WFU concussion guidelines and to the best of your and the individuals knowledge are they free from concussion/post concussion risk?*

Agree

I will update MSJ Coaching on this prior to the session starting if an incident occurs and their is or COULD be a risk*

Agree

Weekly physical activity (number of occasions in a week, I.e: 1 - rugby training, 1 - Cricket game etc. the total per week)

Once a week
Twice a week
More than Twice

At MSJ we are extremely concerned about the health, physical and mental wellbeing and safety of the players we coach and follow the RFU Headcase guidelines, we ask our parents and players to do the same.
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Accept Terms*

Agree

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By selecting this button I accept that the information contained within this form is shared within MSJ Coaching and with Coaches who will be working with my child for safety reasons and I will inform the coaches of any health changes. I consent to the use of images for MSJ Coaching media and PR purposes (this may include the website and social media sites).

Name*

Todays Date*

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