Ham Manor Golf Club

Junior Open Application Form

Player Name
Date of Birth
Golf Club
CDH / Membership No
Handicap Index
Parent / Guardian Name
Telephone
Email
PARENT/GUARDIAN MEDICAL CONSENT FORM
The safety and welfare of junior golfers is paramount and it is important that we know details concerning their general state of health and their Doctor. Accordingly, we ask you to complete this form with our assurance that the information given will be treated as confidential.
Name of Doctor and Surgery
Doctor Phone No
NHS No
Does your Child suffer from asthma, diabetes, epilepsy, hay fever, migraine or other illness?

If yes, please give details
Is your Child allergic to anything, e.g. elastoplasts, aspirin, nuts or other food?

If yes, please give details
In the unlikely event my Child should require emergency medical, hospital or dental treatment, I hereby authorise a Director of Ham Manor GC or authorised person to sign on my behalf any written consent form required by a hospital or dental authority. Yes
No
Date
The above assumes that a delay in obtaining my signature is considered inadvisable by a doctor, surgeon or dentist.
In the event of a medical emergency, every effort will be made to contact both Parents/Guardians listed on the Player's entry form.
Second Contact Name (Parent / Guardian)
Second Contact Mobile No
Any Additional Comments?
Would you like to receive details of any Future Events?

Please transfer the Entry Fee of £15 (Member) or £25 (Non Member) by BACS to: Sort Code 30-99-93, Account No 46722768, with the Player's Surname followed by 'JO' as the reference. Entry fees are transferable, but not refundable (unless the event is over-subscribed).
Confirm

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