Bawburgh Golf Club Parental Consent Form - August 2015 Page 1

01603 740404 | bawburgh.com | info@bawburgh.com | @bawburghgolf

Glen Lodge Marlingford Road Bawburgh Norwich NR9 3LU

NORWICH FAMILYGOLF CENTRE

PARENTAL CONSENT FORM

PLAYER PROFILE, JUNIOR MEMBERSHIP

THIS FORM WILL BE USED THROUGHOUT THE PERIOD JUNIORS ARE MEMBERS OF THE GOLF CLUB. THE GOLF CLUB MUST KEEP UP TO DATE CONTACT DETAILS OF ALL THEIR JUNIOR MEMBERS. IT IS THE RESPONSIBITLY OF THE JUNIOR AND THEIR PARENTS/GUARDIAN TO NOTIFY THE CLUB SECRETARY IF ANY OF THE DETAILS CHANGE.

PLEASE RETURN COMPLETED FORMS TO THE GOLF OFFICE AT BAWBURGH GOLF CLUB.

* ALL FORMS NEED TO BE SIGNED BY PARENTS/GUARDIANS

CHILD’S NAME: .................................................................................................................................................................... ......

DATE OF BIRTH: ........................................................................... GENDER: MALE FEMALE

ADDRESS: .....................................................................................................................................................................................

.............................................................................................................................................................................................................

...................................................................................................................................POST CODE: ..............................................

PARENTS/GUARDIAN NAME: ..............................................................................................................................................

TELEPHONE: WORK:................................................................................ MOBILE: ............................................................

EMERGENCY CONTACT NAME: .........................................................................................................................................

TELEPHONE: WORK:................................................................................ MOBILE: ............................................................

EMERGENCY CONTACT NAME (2) : ................................................................................................................................

TELEPHONE: WORK:................................................................................ MOBILE: ............................................................

Bawburgh Golf Club Parental Consent Form - August 2015 Page 2

01603 740404 | bawburgh.com | info@bawburgh.com | @bawburghgolf

Glen Lodge Marlingford Road Bawburgh Norwich NR9 3LU

NORWICH FAMILYGOLF CENTRE

MEDICAL INFORMATION

1. CHILDS DOCTOR’S DETAILS

DOCTOR’S NAME: ....................................................................................................................................................................

TELEPHONE: ....................................................................................................................................................................

2. DOES YOUR CHILD EXPERIENCE ANY CONDITIONS REQUIRING MEDICAL TREATMENT AND/OR MEDICATION?

YES NO

IF YES PLEASE GIVE DETAILS :

3. DOES YOUR CHILD HAVE ANY ALLERGIES?

YES NO

IF YES PLEASE GIVE DETAILS :

4. DOES YOUR CHILD HAVE ANY SPECIFIC DIETARY REQUIREMENTS?

YES NO

IF YES PLEASE GIVE DETAILS

5. PLEASE PROVIDE ANY FURTHER INFORMATION THAT YOU FEEL APPROPRIATE

I CONFIRM TO THE BEST OF MY KNOWLEDGE THAT MY SON/DAUGHTER DOES NOT SUFFER FROM ANY MEDICAL CONDITION OTHER THAN THOSE DETAILED ABOVE. I AGREE TO NOTIFY THE CLUB SHOULD THE ABOVE DETAILS NEED TO BE UPDATED/ CHANGED AND IF MY SON/ DAUGHTER SHOULD NOT BE PARTICIPATING DUE TO ILLNESS OR INJURY.

Bawburgh Golf Club Parental Consent Form - August 2015 Page 3

01603 740404 | bawburgh.com | info@bawburgh.com | @bawburghgolf

Glen Lodge Marlingford Road Bawburgh Norwich NR9 3LU

NORWICH FAMILYGOLF CENTRE

I …………………………………………………………… BEING PARENT OR GUARDIAN OF THE ABOVE NAMED CHILD HEREBY GIVE PERMISSION FOR THE JUNIOR ORGANISER/ PGA PROFESSIONAL/ CLUB OFFICIAL TO GIVE IMMEDIATE NECESSARY AUTHORITY ON MY BEHALF FOR ANY MEDICAL OR SURGICAL TREATMENT RECOMMENDED BY COMPETENT MEDICAL AUTHORITIES, WHERE IT WOULD BE CONTRARY TO MY SONS/DAUGHTERS INTEREST, IN THE DOCTORS MEDICAL OPINION, FOR ANY DELAY TO BE INCURRED BY SEEKING MY PERSONAL CONSENT.

I HAVE READ THE CHILD PROTECTION POLICY AND AGREE TO COMPLY WITH THE REQUIREMENTS OF THE “PARTNERING SCHEME” (ABOVE) FOR THE DURATION OF MY CHILDS TIME AS A JUNIOR MEMBER OF THE CLUB.

I UNDERSTAND AND ACCEPT THAT CLUB OFFICIALS MAY TAKE PHOTOGRAPHS OF JUNIORS FOR CLUB PURPOSES ONLY. THESE WLL NOT BE REPRODUCED ON WEB-SITS, OR USED IN PUBLICATIONS.MEDIA WITHOUT EXPRESS PERMISSION BIEING SOUGHTED. THE CLUB WILL FOLLOW THE GUADAINCE FOR THE USE OF IMAGES OF YOUNG PEOPLE AS DETAILED IN THE CHILDREN IN GOLF POLICY & PROCEDURES (AVALABLE ON REQUEST)

THIS CONSENT FORM IS VALID FOR THE WHOLE LENGTH OF TIME THAT THE JUNIOR IS A MEMBER OF THIS CLUB. ANY CHANGES TO THIS FORM ARE TO BE NOTIFED TO THE CLUB, AND ANY CHANGES ARE THE SOLE RESPOSIBILITY OF THE PARENT OR GUARDIAN.

PARENT/GUARDIAN:

NAME: ....................................................................................................................................................................

SIGNATURE : ....................................................................................................................................................................

DATE : ..........................................................................................

JUNIOR :

NAME: ....................................................................................................................................................................

SIGNATURE : ....................................................................................................................................................................

DATE : ..........................................................................................