Blackley Golf Club

New Junior Members & Junior Visitors

In line with our clubs Safegaurding policy we require information from all new Junior members and visiting Junior guests who come to the club for organised coaching.

This information allows us to make contact with parents/guardians in case of emergency.

Please complete all the information below. Information collected will only be kept for the required period and will not be used for marketing purposes. All data will be treated as confidential under the Data Protection Act.

Safeguarding Consent Form

Players Name
Date Of Birth
House Number & Street Name
Town/City
County
Post Code
Telephone Number
Parent 1 Name
Parent 1 Address (if different from player)
Home Telephone
Mobile Number
Work Number
Parent 2 Name
Parent 2 Address (if different from player)
Home Telephone
Mobile Number
Work Number
Additional Emergency Contact
Relationship To Child
Contact Number
Child's Doctor
Surgery Address
Surgery Telephone
Does your child suffer any condition requiring medical treatment and/or medication

Details
Does Your Child Have Allergies

Details
Does your child have any special dietary requirements

Details
Do you consider your child to have a disability

Does your child have any communication issues?

Do you give permission for your child to be included in photographs for BGC promotion

Do you give permission for transportation to/from inter club events?

I, being parent/guardian of the above named child, hereby give permission for the Club responsible person to give the immediately necessary authority on my behalf for any medical or surgical treatment recommended by competent medical authorities, where i

Full name of person giving authority
Preferred Email Address For Contact
Member Or Visitor

Confirm

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