Clandon Regis Golf Club

Junior Membership Application Form

The safety and welfare of children in our care is paramount, and it is therefore important that we are aware of any ILLNESS, MEDICAL CONDITION AND OTHER RELEVANT HEALTH DETAILS in order that their best interests are addressed. Please complete this form with our assurance that the information will be treated as confidential. It is the responsibility of the junior and their parent/ guardian to notify the junior organizer of any of the details change at any time.
........................................................................................................
CONTACT DETAILS
Forename:
Surname:
Date of Birth:
Email Address:
Member's Phone Number:
Address:
Postcode:
PARENT / GUARDIAN INFORMATION:
PARENT / GUARDIAN 1:
Name:
Relationship to child:
Phone Number:
Email Address:
PARENT / GUARDIAN 2:
Name:
Relationship to child:
Phone Number:
Email Address:
...........................................................
MEDICAL INFORMATION
Does your child experience any conditions requiring medical treatment / medication?

If yes, please provide details- Medication name, dose and frequency
Does your child have any allergies?

If yes, provide details below:
Does your child have any specific dietary requirements?

If yes, please give details
Does your child have any additional needs? ( e.g. needs help to administer planned medication, assistance with lifting or access, regular snacks)?
....................................................
DISABILITY
The Disability Discrimination Act 1995 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 son/ daughter to have a disability?

If yes, what is the nature of their responsibility?

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 to communicate with us fully.
.....................................................
THE SMALL PRINT
I confirm to the best of my knowledge that my son/ daughter does not suffer from any medical condition other than those detailed above. I agree to notify CRGC if the above details need to be updated/ changed and if my son/ daughter should not participate in an event/ activity due to illness or injury.
I, being the parent / guardian of the above named child, hereby give permission for the CRGC responsible person to give the immediately necessary authority on my behalf for any medial or surgical treatment recommended by competent medical authorities where it would be contrary to my son's / daughter's interest, int he doctor' medical opinion, for any delay to be incurred by seeking my personal consent.
SIGNED - PARENT / GUARDIAN
Date:
......................................................
GOLFING HISTORY
It is our practice to register new members of Clandon Regis Golf Club (including those who are new to golf) with the system controlled by England Golf. England Golf manages handicaps under the World Handicap System (WHS) for all clubs in England. Data protection considerations require us to have your explicit authorization before registration to pass on the following data: date of Birth, mail Address, and Gender.
Please indicate your choice below:

Do you hold an official handicap?

If yes, what is your current handicap?
CHD Number:
Are you currently a member at another golf club?

If yes, please tell us which club.
Will CRGC be your home club?

....................................................................
PERMISSION FOR THE USE OF PHOTOGRAPHIC IMAGES
This part of the form is to be signed by the legal parent/ guardian of a child or young person under 18, together with the child or young person.

Clandon Regis Golf Club recognises the need to ensure the welfare and safety of all young people in golf. As part of our commitment to this, we will not permit photographs, video images, or other images of young people to be taken without the consent of the parents, carers, and the young person.

If you become aware that these images are being used inappropriately, you should inform the club Child Welfare Officers immediately by calling the office on 01483 224 888 ext.4 or emailing:

Gerry Outram - gerryo@hotmail.co.uk
Julie Risley - julierisley@icloud.com

If, at any time, either the parent/ carer or the young person wishes for their image to be removed from the CRGC website, 7 days' notice must be given to the secretary, after which time the image will be removed.

I, parent/ guardian, consent to CRGC photographing this young person under the stated rules and conditions. I confirm I have legal parental responsibility for this child and am entitled to give this consent. I also confirm that there are no restrictions related to taking photographs.
Parent/ Guardian signature
Date
To be completed by the young person:
I consent to CRGC photographing my involvement in golf under the stated rules and conditions.
Young person sign here:
Date:
I apply for membership to Clandon Regis Golf Club Ltd and agree to abide by the Club Rules and terms and conditions of membership set out therein.
I agree to the Code of Conduct for Young Golfers at Clandon Regis Golf Club.
Confirm

Click here to view Membership Terms & Conditions.

Click here to view Code of Conduct for Young Golfers.

Created by intelligentgolf version 10.1.2.