Lasswade Athletics Club

Parental Consent Form

Completion of this form allows the named athlete to travel and compete for
Lasswade Athletics Club covering Summer Track & Field, Winter Cross Country
& the Winter Indoor League season.

CHILD'S DETAILS:First Names

(Please Print)
Surname
D.O.B

(Please Print)

Address
(

Please Print)
Post Code
Please detail any relevant Medical Information of which Lasswade Athletics
Clubs Coaches/Team Managers should be aware.

(Please Print)

Emergency Contact Name: -

Emergency Contact No:-

In case of Emergency Only:Doctor's Name:Doctor's Telephone No:I here by give my permission for my child to travel & compete with and for
Lasswade Athletics Club
Parent/Guardian Name
(Please Print)
Signature
Contact Tel Nos:Day

Chairman: Brian Wilson

Evening

Secretary: Norrie Kristoffersen

Mobile No:-

Treasurer: Barbara Howie

Welfare Officer: Alison Chalmers
Membership Secretary: John Brash
Tel No 0131-621-0188 Mob No 07793862518 Email: johnbrash1@hotmail.com

Completed Forms to be sent to:- John Brash[LAC Membership Secretary ]

Please Return completed form to address below/ or at any training night
John Brash
95 Gilmerton Dykes Crescent
Edinburgh. EH17 8JW

Chairman: Brian Wilson

Secretary: Norrie Kristoffersen

Treasurer: Barbara Howie

Welfare Officer: Alison Chalmers
Membership Secretary: John Brash
Tel No 0131-621-0188 Mob No 07793862518 Email: johnbrash1@hotmail.com