Loco Parentis Form 2025






    Guildford City Swimming Club – Loco Parentis Form


    Swimming Camp 14th to 21st February 2025 – Fuerteventura


    To be completed by members aged 18 years or over, or by parents of members under 18 years – Separate forms should be completed for each swimmer.
    Please complete each box as requested.

    Full Name of swimmer as on passport

    Swimmer’s Date of birth

    Swimmer’s ASA Membership Number

    Swimmer’s Age as at 14.02.2025

    Swimmer’s Full Postal Address

    Swimmer’s Mobile Number for Whatsapp Group Whilst on Camp

    First Emergency Contact Name, Relation To Swimmer & Mobile

    Name

    Relation to Swimmer

    Mobile

    Second Emergency Parent Name & Mobile

    Name

    Relation to Swimmer

    Mobile

    PLEASE STATE YES / NO AGAINST STATEMENTS BELOW

    A. YES I/we GIVE consent for any of the Team Managers/Coaches named below to act in loco parentis. Should there be a medical emergency they can give permission to qualified medical professionals to undertake medical treatment on our behalf if I/we are unavailable to do so.

    B. NO I/we DO NOT give consent for any of the Team Managers/Coaches named below to act in loco parentis. Should there be a medical emergency they can give permission to qualified medical professionals to undertake medical treatment on our behalf if I/we are unavailable to do so.

    Please tick Yes or No YesNo

    By entering your names below, you are electronically signing this form.

    NAME 1:

    NAME 2:

    Riaan Steyn – Coach
    Ben Rowett – Coach
    Caroline Wood – Team Manager
    Janette Smith – Team Manager
    Julie Punter – Team Manager

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