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Brokenhurst Manor Golf Club

Junior Consent Form



Parental Consent

Please see below the Junior Consent criteria. 

Personal Information







Emergency Contact Information







Medical Information 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 SPECIFY






Doctor


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.

Yes
No





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