Junior Profile and Parental Consent Form – CHESHAM & LEY HILL GOLF CLUB

Junior Profile and Parental Consent Forms

FOR PLAYERS UNDER THE AGE OF 18

Player profiles forms enable those responsible for children to have the information they need to deal effectively with any emergency situation that arises.

Although information obtained on these forms must be treated as confidential (and only given to those who need it to fulfil a duty of care for the child), it is also critically important this information is readily to hand at sessions and matches.

Use the Form below

Junior refers to a person under the age of 18 years.
A junior between the ages of 16 and 18 years old must play with a responsible person who is 16 years or older.
A junior between the ages of 12 and 16 years old must play with a parent or Guardian or a responsible person who is 16 years or older.
A junior who is 12 years old or younger must play with a parent, guardian or an adult who is 18 years or older.
When playing golf at Chesham and Ley Hill Golf Club a junior 12-18 years old must carry a mobile phone which is switched on. This is a necessary precaution to deliver enhanced protection.

The safet y and welfare of juniors in our care is paramount, and it is therefore important that we are aware of any illness, medical condition, and other relevant healt details so that their best interests are addressed.

In compliance with the Data Protection Act 2018, GDPR and all relevant data protection legislation, all efforts will be made to ensure that information is accurate, kept up to date and secure and that it is used only in connection with the purpose and activities of the organisation. Information will not be kept once a person is no longer a member of the organisation. The information will be disclosed only to those members of the organisation for whom it is appropriate and relevant officers of England Golf where necessary.

It is the responsibility of the junior and their parent/carer to notify the Club Welfare Officer (CWO) or Secretary if any of the details change at any time.

Junior Name

Date of Birth

Address

Telephone Number

Parents Names

Address (If different from above)

Home Telephone Number

Mobile Telephone Number

Work Telephone Number

Emergency Contacts

Contact 1 Name

Relationship to Child

Home Telephone Number

Moblie Number

Work Telephone Number

Contact 2 Name

Relationship to Child

Home Telephone Number

Mobile Number

Work Telephone Number

Confirm details of all those with parental responsibility for the child

Medical Information

Child’s Doctor’s Name

Doctor’s Surgery Address

Surgery Telephone Number

Does your child experience any conditions requiring medical treatment and/or medication

Yes No

If yes, please give details, including medication, dose and frequency

Does your child have any allergies

Yes No

If yes, please give details

Does your child have any specific dietary requirements?

Yes No

If yes, please give details

What additional needs, if any does your child have e.g. needs help to administer planned medication, assistance with lifting or access, regular snacks?

Disability

Do you consider your child to have a disability?

Yes No

If yes, what is the nature of the disability?

Does your child have any communication needs e.g. non-English speaker / hearing impairment / sign language user / dyslexia?

Yes No

If yes, tell us what we need to do to enable him/her to communciate with us fully

Consent from Parent / Legal Carer

I confirm to the best of my knowledge that my child does not suffer from any medical condition other than those detailed above

Yes No

I agree to notify the Club of any changes to this information

Yes No

The attached signature will denote that my child has my permission to be on the golf club’s premises.

Yes No

I acknowledge that the club is not responsible for providing adult supervision for my child, except for formal junior golfing coaching, matches or competition.

Yes No

I agree to my child being transported by club representatives to and from venues when he/she is representing the club.

Yes No

By signing this document, I confirm that I have legal responsibility for

I am entitled to give this consent and I am aware of how the information I have provided may be used

Yes No

Signed (Parent or Carer)

Date