faversham golf club - junior open 2021 please fully complete the following: parent / guardian consent form full name of child date
FAVERSHAM GOLF CLUB - JUNIOR OPEN 2021
PLEASE FULLY COMPLETE THE FOLLOWING:
PARENT / GUARDIAN CONSENT FORM
Full name of child
Date of birth
Age (on 1st January 2021)
Full home address
Post code
Home telephone number
Mobile telephone number
Parent(s) email address
It is of utmost importance that you bring to our attention all medical
conditions, allergies and/or illness that your child may suffer from,
and whether he/she is currently receiving medical treatment of any
kind. Please indicate below any health-related matter which you think
we should be made aware of, including details of any prescribed
medication and dosage, specific dietary requirements and allergies.
All information given will be treated in the strictest confidence.
MEDICAL TREATMENT:
PRESCRIBED MEDICATION:
DOSAGE / FREQUENCY:
ALLERGIES:
DIETARY REQUIREMENTS:
“My child is in good health and I give consent to him/her
participating in this golf event. I confirm that to the best of my
knowledge, my child does not suffer from any medical condition other
than detailed above. Should it be deemed necessary by a qualified
medical practitioner, I give full permission for my child to receive
essential emergency medical or surgical treatment.”
SIGNED (parent/guardian):
PRINT NAME (parent/guardian):
MEDICAL DETAILS – PLEASE PRINT
Child’s GP Name
Telephone Number of GP
GP Surgery Name & Address
EMERGENCY CONTACT DETAILS – PLEASE PRINT
Name
Relationship to Child
Home telephone number
Mobile telephone number
ALTERNATIVE EMERGENCY CONTACT – PLEASE PRINT
Name
Relationship to child
All contact numbers
I do / do not* consent to my child being photographed for possible
inclusion in newspaper or golfing magazines etc (*please delete as
necessary)
PLEASE NOTE:
IT IS THE DUTY OF THE PARENT OR GUARDIAN TO ADVISE US OF ANY AND ALL
CHANGES IN THE INFORMATION STATED HERE, PRIOR TO THE JUNIOR OPEN
TAKING PLACE. ALL INFORMATION ON THIS FORM WILL BE TREATED IN THE
STRICTEST CONFIDENCE AND WILL NOT BE PASSED TO ANY THIRD PARTY UNLESS
REQUIRED TO DO SO FOR HEALTH REASONS (e.g: if required by an attending
doctor or medical personnel).
THIS FORM WILL BE DESTROYED AFTER THE 2021 FGC JUNIOR OPEN