Parental Consent :: Midland Golf union

Midland Golf Union

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 it is important that the Midland Golf Union know whether he suffers from any medical condition or illness, or whether he 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 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 receiving essential medical treatment, as necessary, when the treatment is prescribed by a qualified medical practitioner.

Consent Yes
No

I consent to my son 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
MGU Secretary
24 Ayston Road

Uppingham

Rutland LE15 9RL

Tel: (H) 01572 823036, (M) 07906156701

email: secretary@midlandgolfunion.co.uk

Parental Consent - Boys

Parental Consent - Girls

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