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Please Note: Post December 2003 current details updated on BJA Website

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British Judo Association

Locus Prentiss Form.

Name of Judo Player: ______________________________________________________________                                     Date of Birth: ___________________

Details of Parent/Guardian to Contact in Case of Emergency:

Name: _____________________________________________________________________________________________________                       Relationship:____________________

Address:___________________________________________________________________

__________________________________________________________________________________________________________________________         Postcode: _____________________

Phone (h): ___________________________________________________________________________________                                                  Phone (w): _______________________________________________________________________

Phone (m):____________________________            E-mail:_________________________

Details of another person to contact if parents/guardian are unobtainable:

Name: _____________________________________________________________________________________________________                       Relationship:____________________

Address:___________________________________________________________________

_____________________________________________________________________________________________________________________                       Postcode: _____________________

Phone (h): ____________________________________________________________________________________________                       Phone (w): _______________________________________________________________________

Phone (m):______________________________       E-mail:_________________________

I hereby authorise Representatives of the British Judo Association to act on my behalf, with regards to my/our child, In the event of an emergency and to sign on my/our behalf any consent from as required by medical or legal agencies in my/our absence. I also consent to my daughter submitting to doping control procedures in force at the event.

Signature of parent(s)/Guardian(s):

Name: ___________________________________________________________________________________________________                             Date: _______________________________________________________________________________________

Name: __________________________________________________________________________________________________                                Date: ___________________________