MIDLAND GOLF UNION LTD
PARENTAL CONSENT FORM
Date Name of Child Address 1 Address 2 Town County Post Code Telephone Number Email Address Childs Age Childs DOB In caring for the best interests of your son/daughter it is important that the Midland Golf Union know whether he/she suffers from any medical condition or illness, or whether he/she is currently receiving medical treatment of any kind
Please indicate below, in confidence, any heath related matters including injuries of any kind, which you think it is best we know about, including details of any prescribed medicine and dosage or of any special dietry requirements. If none type N/A
Medical Conditions My son/daughter is in good heath and consent to him participating in events and activities organised by the Midland Golf Union.
Consent Yes No I consent to my son/daughter receiving essential medical treatment, as necessary, when the treatment is prescribed by a qualified medical practitioner.
Consent Yes No I consent to my son/daughter being photographed for the purpose of publicity.
Consent Yes No His NHS Doctor is Address 1 Address 2 Town County Post Code Telephone Number Childs NHS Number Name of Parent/Guardian Telephone Number (H) Telephone Number (M) Telephone Number (W) IN THE EVENT OF ANY CHANGES TO THE ABOVE INFORMATION, PLEASE NOTIFY:
Neil Harris
Tel: 01754 763159
M: 07906 156701
E: secretary@midlandgolfunion.co.uk
