The Hampshire Golf Academy
Junior Academy Registration/Consent Form
* Required
Child’s Full Name:
*
Your answer
Date of Birth (DD/MM/YYYY):
*
Your answer
Parent’s Name:
*
Your answer
Parent’s Email Address:
Your answer
Address
*
Your answer
Phone number
Your answer
Known Medical Conditions, Requirements and/or Allergies:
*
Your answer
Child’s Doctor’s Name:
*
Your answer
Known Specific Dietary Requirements:
*
Your answer
Do you consider your child to have a disability?
*
Your answer
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.
*
Yes
No
Required
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).
*
Yes
No
Required
I consent to my child taking part in golfing activities on The Hampshire Golf Club’s premises.
*
Yes
No
Required
Any other relevant information?
Your answer
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