Junior Profile Form :: Friendly

Buckinghamshire County Ladies Golf Association

Email: info@bclga.org.uk

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Woburn Golf Club

Harleyford Golf Club

Gerrards Cross Golf Club

Ellesborough Golf Club

Denham Golf Club

Chesham and Ley Hill Golf Club

Burnham Beeches Golf Club

Buckingham Golf Club

Wycombe Heights Golf Club

Thorney Park Golf Club

Beaconsfield Golf Club

Chiltern Forest Golf Club

Child's Name
Child's Date of Birth
Child's Address
Parent/Carer 1 Name
Parent/Carer 1 Address (if different to Child)
Parent/Carer 1 Mobile Telephone
Parent/Carer 1 Home Telephone
Parent/Carer 1 email address
Parent/Carer 2 Name
Parent/Carer 2 Address (if different to Child)
Parent/Carer 2 Mobile Telephone
Parent/Carer 2 Home Telephone
Parent/Carer 2 email address
Other Emergency Contact 1 Name
Other Emergency Contact 1 Relationship to Child
Other Emergency Contact 1 Mobile Telephone
Other Emergency Contact Home Telephone
Other Emergency Contact 2 Name
Other Emergency Contact 2 Relationship to Child
Other Emergency Contact 2 Mobile Telephone
Other Emergency Contact 2 Home Telephone
Child Doctor/GP Surgery Name
Child Doctor/GP Surgery Telephone
Does your child experience any conditions requiring medical treatment and/or medication? Yes
No
If yes, please give details, including medications, 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 to help administer planned medication, assistance with lifting or access, regular snacks?
Does your child have any communication needs, e.g. non-English speaker, hearing impairment, sign language user, dyslexia? Yes
No
If ye, please tell us what we need to do to enable her to communicate with us
Do you consider your child to have a disability as defined in the Equality Act 2010? Yes
No
If yes, what is the disability?

If Other, please specify
DECLARATION

I confirm that I am the legal parent/carer of the child named above and am entitled to give these consents.
I confirm to the best of my knowledge that my child does not suffer from any medical conditions other than those detailed above.
I agree to notify BCLGA of any changes.
Being parent/carer of the above-named child, I hearby give permission for the BCLGA responsible person to give the immidiately necessary authority on my behalf for any medal or surgical treatment recommended by competent medical authorities, where it would be contrary to my child's interest, in the doctor's medical opinion, for any delay to be incurred by seeking my personal consent.
My child has my permission to be on a golf club's premises for the purposes of coaching, matches and competitions Yes
No
I acknowledge that BCLGA is not responsible for providing adult supervisions for my child except for formal junior coaching, matches or competition Yes
No
I consent to BCLGA photographing or videoing my child under the stated rules and conditions Yes
No
I consent to the data provided on this form being held on the BCLGA junior database Yes
No
I consent to our email adresses being used to keep us informed of BCLGA activities and events Yes
No
Name of Parent/Carer submitting the form
Date form submitted
Confirm

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