County Championships Team Event Entry Form

Junior Profile & Parental Consent Form

(For players under the age of 18)
The safety and welfare of juniors in our care is paramount, and it is therefore important that we are aware of any illness, medical condition and other relevant health details so that their best interests are addressed. In compliance with the Data Protection Act 1998, all efforts will be made to ensure that information is accurate, kept up to date and secure and that it is used only in connection with the purpose and activities of the organisation. Information will not be kept once a person is no longer a member of the organisation. The information will be disclosed only to those members of the organisation for whom it is appropriate and relevant officers of England Golf where necessary. It is the responsibility of the junior and their parent/carer to notify the County Welfare Officer (CWO) Ian Griffiths Tel:07463-687901 Email: menssecretary@worcestershireamateurgolf.co.uk) if any of the details change at any time.
Name of junior:*

First NameLast Name
Date of Birth of Junior:*

DayMonthYear
Date
Contact Phone Number:*
Please enter a valid phone number.Format: 00000000000.
Contact Email:
example@example.com
Contact Address:*

Street Address

Street Address Line 2

CityCounty

Postcode
Name of parent:

First NameLast Name
Contact Phone Number:
Parent E-mail:
example@example.com
Emergency Contact 1:
Emergency Contact 2:
Medical Information:
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 specific dietary requirements?

Yes*No
*If Yes, please give details.
Does your child have any allergies?

Yes*No
*If Yes, please give details.
What additional needs, if any, does your child have e.g. needs help to administer medication, assistance with lifting or access, regular snacks?
The Equality Act 2012 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?

Yes*No
*If Yes, please give details.
Does your child have any communication needs e.g. non-English speaker/ hearing impairment/ sign language user/ dyslexia? If yes, please tell us what we need to do to enable him/her them to communicate with us fully.

Yes*No
*If Yes, please give details.
Photography & Video Consent

The WCG LTD 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 or other images of your child to be taken or used without your consent. The WCG LTD will take steps to ensure that any images are used solely for the purposes for which they are intended, ie the promotion and celebration of the activities. Images may be used on our website, social media feeds, press and promotional material.
I agree that photographs, videos or other images can be taken of my child during WCG LTD events, matches, coaching sessions and championships.

Yes*No
I consent to date being shared with England Golf to enable any Regional or National opportunities to be communicated.

Yes*No
Data Protection Act
Please put me on the WCG LTD database and keep me informed of golfing matters.

Yes*No
Consent from Parent/Legal Carer:
I confirm to the best of my knowledge that my child does not suffer from any medical condition other than those detailed above.*
I agreed to notify the County of any changes to this information*
I give my consent that in an emergency situation, the County may act in my place (loco parentis), if the need arises for the administration of emergency first aid and/or other medical treatment which, in the opinion of a qualified medical practitioner, may be necessary. I also understand that in such an occurrence all reasonable steps will be taken to contact me or the alternative adult named in this form *
The attached signature will denote that my child has my permission to be on the premises where county activities are taking place *
I acknowledge that the county is not responsible for providing adult supervision for my child, except for formal junior golfing coaching, matches or competition *
I agree to my child being transported by county representatives to and from venues when he/she is representing the county *
By signing this document I confirm that I have legal responsibility for enter name of child * ; I am entitled to give this consent and I am aware how the information I have provided may be used.
Parent / Guardian signature
Print name:

First NameLast Name
In ensuring that a young person is aware of the contents of this form, we ask that the Young person named signs to confirm:
Date

DayMonthYear
Date
Should be Empty:

Junior Profile & Parental Consent Form

Photography & Video Consent

Data Protection Act

Consent from Parent/Legal Carer: