Codicote Tennis Club - Trip and activity consent form


I do/do not (please delete as appropriate) give permission for my child:

_______________________________________________________ (child’s full name)

to attend the following trip/activity: __________________________________________


Signed

Date:

Name (please print)

Relationship to child
Address




Contact numbers:

Home

Mobile

Work

Email address


Further emergency contact details, if different from above:

Name (please print)

Relationship to child
Address




Contact numbers:

Home

Mobile

Work
Email address


Please use the box below to describe any special care needs, dietary requirements, allergies or medical conditions:




















Please return this form to:

Name (please print)
Address or instructions for returning form













LTA Child Protection
T: 0208 487 7008/7116
M (24 hour): 07971 141 024
E: childprotection@lta.org.uk
www.LTA.org.uk/childprotection