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Effingham Golf Club
Effingham Golf Club
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Junior Open Consent Form
Members'
Login
Players Name
Address
Home Tel
Players Mobile Tel
Players email address
Players Date of Birth
Parent/Guardian Name
Home Tel
Mobile Tel
Parental Email
Relationship to child
Secondary Parent/Guardian Contact Name (Optional)
Secondary Phone number
Secondary Email Address
Medical - Does your child have any medical problems that the Club needs to be aware of?
Diabetes
Epilepsy
Migraine
Asthma
Hay Fever
Sensitivity to insect bites/stings
Allergic to Penicillin or any other medicine
Allergic to foods such as nuts, seafood, dairy (please specify below)
Currently receiving any medical treatment (please specify below)
Medical - Additional information
Is the child's tetanus injection up to date?
Please select
Yes
No
Any other medical issues the club should be aware of?
Registered Doctor
Doctors Address
Doctors Tel
Confirm acceptance of the Declaration (above)
Parent/Guardian Name
Signature
Date
Confirm
