Child’s Full Name: *

Date of Birth (DD/MM/YYYY): *

Parent’s Name: *

Parent’s Email Address:

Address *

Phone number

Known Medical Conditions, Requirements and/or Allergies: *

Child’s Doctor’s Name: *

Known Specific Dietary Requirements: *

Do you consider your child to have a disability? *

Do you give permission for The Hampshire Golf Academy responsible person to give the immediate necessary authority on your behalf for any medical or surgical treatment (including dentistry) recommended by competent medical authorities, where it would be contrary to your child’s interest, in the doctor’s medical opinion, for any delay to be incurred by seeking your personal consent. *

I give my consent to The Hampshire Golf Academy photographing or videoing my child (sometimes this is done during coaching session or for publicity purposes). *

I consent to my child taking part in golfing activities on The Hampshire Golf Club’s premises. *

Any other relevant information?