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Brokenhurst Manor Golf Club
Please see below the Junior Consent criteria.
Personal InformationName of child Address Postcode Phone Number Date of birth Email Address NHS Number Emergency Contact InformationFull Name Phone Number Alternative Phone Number(If required) Email Address Relationship Medical InformationCondition None Diabetes Epilepsy Migraine Asthma Hayfever Sensitivity to Bites/Stings ALLERGIC TO FOODS CONTAINING; Cereals that contain gluten, Crustaceans, Eggs, Fish, Peanuts, Soybeans, Milk, Nuts, Celery, Mustard, Sesame, Sulphur Dioxide, Lupin or Mollusc. IF YES, PLEASE SPECIFYFood Allergy Medicine Allergy Any other condition Current Medication/Medical Treatment Tetanus Injection up to date? DoctorDoctor's Name Address Telephone Number I consent to my child taking part in the golfing activities under the auspices of the Brokenhurst Manor Golf Club. In the unlikely event of an accident or illness requiring emergency medical, hospital or dental treatment, I authorise Brokenhurst Manor Golf Club or its agents to sign on my behalf any written form of consent required by a hospital, medical or dental authority if delay in obtaining my signature is considered inadvisable by the doctor, dentist or surgeon. (In any such eventuality every attempt would be made to contact you). I also consent to the use of photographic, video and other images being published solely in relation to the promotion and celebration of the activities of the club in sports websites, newspapers or magazines.Consent Granted Yes No Confirm
I consent to my child taking part in the golfing activities under the auspices of the Brokenhurst Manor Golf Club. In the unlikely event of an accident or illness requiring emergency medical, hospital or dental treatment, I authorise Brokenhurst Manor Golf Club or its agents to sign on my behalf any written form of consent required by a hospital, medical or dental authority if delay in obtaining my signature is considered inadvisable by the doctor, dentist or surgeon. (In any such eventuality every attempt would be made to contact you). I also consent to the use of photographic, video and other images being published solely in relation to the promotion and celebration of the activities of the club in sports websites, newspapers or magazines.