Parental Consent | Cumbria Union of Golf Clubs

Parental Consent Form

Player Details

Please complete this form with our assurance that the information will be treated as confidential. Once a PCF is registered it covers a 3 year period however it is the responsibility of the junior golfer and their parent/guardian to notify CUGC if any of the details change at any time by submitting a new parental consent form (e.g. change of address, change of Doctor, new medical condition etc.)

Player Given Name *

Player Family Name *

Address Line 1 *

Address Line 2

Town/City *

Post Code *

Parent/Guardian Contact Details

Parent/Guardian Given Name *

Parent/Guardian Family Name *

Relationship to Player *

Same Address as Player? *

Use as Emergency Contact? *

If parent/guardian address is different from player, please enter below:

Guardian Address Line 1 (if different)

Guardian Address Line 2

Guardian Town/City

Guardian Post Code

Email Address *

Mobile Phone *

Work Phone (optional)

Emergency Contact Details

Complete this section only if emergency contact details are different from parent/guardian above.

Emergency Contact Given Name

Emergency Contact Family Name

Relationship to Player

Emergency Contact Email

Emergency Contact Mobile

Emergency Contact Work Phone

Player Doctor/GP Details

Doctor/Practice Name *

Doctor/Practice Phone Number *

Practice Address Line 1

Practice Address Line 2

Practice Town/City

Practice Post Code

Medical & Additional Information

Please indicate if the player has any of the following. If yes, please provide details in the text field.

Communication Needs? *

Communication Needs Details (if yes)

Medication Needs? *

Medication Needs Details (if yes)

Allergies? *

Allergies Details (if yes)

Dietary Requirements? *

Dietary Requirements Details (if yes)

Additional Needs? *

Additional Needs Details (if yes)

Disability? *

Disability Details (if yes)

Consent & Declarations

Please tick all boxes below to confirm your agreement with the following statements:

Medical Condition Confirmation *

Notification of Changes *

Medical Treatment Consent *

Premises Permission *

Supervision Acknowledgement *

Transportation Consent *

Signature *