Zoe Allen Golf - Parental Consent Form

I am committed to the safety and welfare of juniors during Golf coaching and the activities I organise. It is therefore important that I am aware of any illness, medical condition and other relevant health details of the Junior so that their best interests are addressed.

Please complete this form to provide me with all the relevant details and your consent as a parent or guardian. There is also a section to complete regarding the use of photography.

All information gathered is for the sole use of Zoe Allen Golf and will not be passed on to any other body and will be regarded as strictly private & confidential. Please ensure that I am notified if any of the details change at any time.

Junior Golfer's Details

Junior Golfer's Name

Junior Golfer's Forename*

Junior Golfer's Surname*

Golfer's Gender & Date of Birth

Date of Birth*

Age

Gender* Female
Male

Golfer's Address Details

Golfer's Contact Details

Address Line 1*

Address Line 2

Town or City*

County*

Postcode*

Home Telephone Number*

Mobile Number

eMail address*

Confirm eMail address

Is your Parent's address the same as the Golfer's address?

Parent or Guardian's Details

Title*

Forename*

Surname*

Relation to Golfer*

Address Line 1*

Address Line 2

Town / City*

County*

Postcode*

HomeTelephoneNumber*

Mobile Number

WorkTelephone Number*

Parent's eMail address*

Confirm parent's eMail address

Emergency Contact Details

Please provide the names and contact numbers of two people known to the Junior that I can contact in the case of an Emergency.

Contact #1 Details

Contact's Forename*

Contact's Surname*

Home Telephone Number*

Mobile Number

Work Number

Contact #2 Details

Contact's Forename

Contact's Surname

Home Telephone Number

Mobile Number

Work Number

Medical Information

Doctor's Details

Doctor's Name*

Doctor's Telephone Number*

Doctor's Surgery Address

Address Line 1*

Address Line 2

Town or City*

County*

Postcode*

Medical Conditions / Allergies / Dietary Requirements

Does your child experience any conditions requiring medical treatment and/or medication?* Yes No

If yes please give details, including medication, dose and frequency.

Does your child have any allergies?* Yes No

If you have allergies, please provide details here

Does your child have any specific dietary requirements?* Yes No

If yes please give details.

Disability

The Equality Act 2010 defines a disabled person as ‘anyone with a physical or mental impairment, which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities’.

Do you consider your child to have a disability?* Yes No

Communication

Does your child have any communication needs e.g. non-English speaker/ hearing impairment/ sign language user/ dyslexia?* Yes No

Photography

Zoe Allen Golf recognises the need to ensure the welfare and safety of all children in golf. As part of our commitment to ensure their safety we will not permit photographs, video images or other images of your child to be taken or used without your consent.

Zoe Allen Golf will follow the guidance for the use of images of children as detailed within the Child Protection Policy and Procedures.

Zoe Allen Golf will take steps to ensure these images and videos are used solely for the purposes for which they are intended i.e. the promotion, achievement and celebration of the activities.

The photographs may be available on www.zoeallengolf.com, Zoe Allen Golf Facebook, twitter or instagram. If at any time either the parent/ guardian or the child wishes the data to be removed, the data will be removed.

By selecting Yes you are providing photography consent.

I consent to Zoe Allen Golf photographing or videoing the above named child under the stated rules and conditions, and I confirm I have legal parental responsibility for this child and am entitled to give this consent.* Yes No

Declaration

I confirm to the best of my knowledge that my child does not suffer from any medical condition other than those detailed above.

I agree to notify Zoe Allen Golf of any changes.

I hereby give permission for my child to be on the golf club’s premises.

I confirm that I am the parent/guardian of the above named child and hereby give permission for the responsible person to give the immediate necessary authority on my behalf for any medical 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.*

Thank you, your parental consent form has been accepted and will be held on file.

The Equality Act 2010 defines a disabled person as ‘anyone with a physical or mental impairment, which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities’.

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