Ingestre Park Golf Club

Junior Player Details Form

Child's Name
Date of Birth
Address
Telephone Number
I give permission for my son/daughter to have photographs/video images taken. I understand that the said photographs/images may appear in local press, on the website and the Club's online social media pages, including Facebook and/or within promotional ma

Parents' Names
Address (if different from above)
Home Telephone Number
Mobile Telephone Number
Work Telephone Number
Emergency Contact 1 - Name
Relationship to Child
Home Telephone Number
Mobile Telephone Number
Work Telephone Number
Emergency Contact 2 - Name
Relationship to Child
Home Telephone Number
Mobile Telephone Number
Work Telephone Number
Medical Information - Child's Doctor's Name
Doctor's Surgery Address
Telephone Number
Does your child experience any conditions requiring medical treatment and/or medication?

*If Yes please give details, including medication, dose and frequency
Does your child have any allergies?

*If Yes please give details
Does your child have any specific dietary requirements?

What additional needs, if any, does your child have e.g. needs help to administer planned medication, assistance with lifting or access, regular snacks?
The Disability Discrimination Act 1995 defines a disabled person as 'anyone with a physical or mental impairment, which has substantial & long term adverse affect on ability to carry out normal day to day activities'. Tick and Continue to next question
Do you consider your child to have a disability?

*If Yes what is the nature of the disability? Hearing impairment
Learning disability
Physical disability
Multiple disability
Other
*If Other, please specify
Confirm