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CONSENT AND EMERGENCY PERMISSION

To be filled in by parents of members under 18 years of age:-

I wish my son to be allowed to take part in the activities of the Kangaroos Gymnastics and
Trampoline Display Team, and agree to his taking part in any or all of the activities
undertaken by the team, as previously made known to me by the Chairman of the
Kangaroos.

I understand that, while the adult (over 18 years of age) members of the Team will take all
reasonable care of younger team members, they cannot necessarily be held responsible
for any loss, damage or injury suffered by my son arising out of the above agreed activities.

I ________________________________________, give consent to

(YOUR NAME IN BLOCK CAPITALS)
the medical examination of my son when necessary whilst he is taking part in the visit, and
I request that any operation or any other measures considered necessary by a medical
authority for his diagnosis and treatment shall be performed, and I hereby give my
permission for such operation or other measures to be carried out in an emergency only,
and for the administration of a general or local anaesthetic if necessary.

To be filled in by members over 18 years of age:-

I ________________________________________, give consent, in

(YOUR NAME IN BLOCK CAPITALS)
event of my incapacity or loss of consciousness, to any medical examination when
necessary, and I request that any operation or any other measures considered necessary
by a medical authority for diagnosis and treatment shall be performed, and I hereby give
my permission for such operation or other measures to be carried out in an emergency
only, and for the administration of a general or local anaesthetic if necessary.

Signature:__________________ Date:___/___/2010

Photographic, video and Television Consent

I hereby give permission for photographic and video images to be taken of my son/myself
to be taken, printed and reproduced or broadcast in literature and items produced by The
Kangaroos, or by other organisations, with his/my approval.

I also give permission for my son/myself to take part in recorded or live television
productions if these are part of a Kangaroos Gymnastics Display Team display or
organised activity undertaken by the Team, with my knowledge.

Signature:__________________ Date:___/___/2010