Millisle Primary School & Nursery

Glastry & Portavogie Football / Rounders Tournament

For reasons of safety and security, forms will be accepted only from parents/guardians using the correct password. The password will be sent to parents/guardians who are connected to Class Dojo. Please type the password as given to you.

Child's First Name

Child's Surname

Class (Please select the correct class)

I consent to my child taking part in this event.

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 son/daughter returning home from the visit due to unforeseen circumstances.

I agree to my son/daughter 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 Contact Number

Password (For safety reasons, consent forms are password protected. The password will be sent to parents/guardians who are connected to Class Dojo. Please type the password as given to you.)

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Glastry & Portavogie Football / Rounders Tournament

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