Millisle Primary School & Nursery

Football Tournament

Please note that this form is to be used only if your child has been asked to participate in the football team.

Child's First Name

Child's Surname

Class (Please select the correct class - Nursery to P7)

I consent to my child taking part in this activity on the following dates: November 25th 2026, January20th 2027, February 24th 2027 and April 21st 2027

I confirm to the best of my knowledge that he/she is medically fit to participate.

Any current medical condition ( if none, please state NONE)

Post medical condition e.g. following a medical procedure or illness (if none, please state NONE)

Any medication being taken (if none, please state NONE)

Any other relevant information which may affect his/her participation in the event, including allergy or dietary requirements ( if none, please state NONE)

I accept the established code of conduct for the visit and agree to the arrangements relating to my child returning home from the visit due to unforeseen circumstances.

I agree to my child receiving emergency medical treatment, including anaesthetic/ blood transfusion, as considered necessary, by the medical authorities present. I understand the extent and limitations of the insurance cover provided.

Parent/Guardian Name

Parent/Guardian Number

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Football Tournament

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