We the parents of *

Players Name

First Name

Last Name

Authorise James Potter and Alexandra Potter to act as guardians to our child during the period of *

Tour Date Start

MM

DD

YYYY

Until *

Tour Date Finish

MM

DD

YYYY

Parents Name *

I consent to them acting as my/our representative in a medical emergency.

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Players Date of Birth

MM

DD

YYYY

Emergency Contact 1 Name *

First Name

Last Name

Emergency Contact 1 Number *

(###)

###

####

Emergency Contact 2 Name *

First Name

Last Name

Emergency Contact 2 Number *

(###)

###

####

Date of last Tetanus injection

MM

DD

YYYY