Junior Open 2024 - Entry Form

Junior Open 2024 Entry Form

Enter not this field:

Name of player

Name of Child:*

Home Club:*

Date of Birth:*

Current Handicap:*

CDH Number:*

Address:*

Postal Code:*

E-mail:*

Medical

Medical condition or illness:
	To enable us to care for the best interest of your child, it is important that we know whether he/she suffers from any medical condition or illness, or whether she/he is currently receiving medical treatment of any kind. Please indicate below, in confidence, any health related matter which you think it is best we know about, including the details of any prescribed dosage or special dietary requirements:

NHS Number:*

NHS Doctor:*

Address of Surgery:*

Post Code:*

Telephone number:*

Name of Parent or Guardian:*

Contact telephone number (mobile):*

To comply with Child Protection Law please tick the box:*

Consent of Parent or Guardian

Consent:*
	My child is in good health and I consent to her/him participating in golf events. I consent to my child receiving essential medical treatment, as necessary, when a qualified practitioner prescribes the treatment.

Electronic Signature:*
	This form will be kept until the end of 2022 and will then be shredded. No information held on this form will be passed to a third party. I consent to my child being photographed for possible inclusion in Dorset County Golf Union Books

Payment Details - Please tick if you are transferring the entry fees via a BACS payment to

Knighton Heath Golf Club Ltd, Account 00113811, Sort Code 30-96-73:
	Please use your surname as the reference followed by JO

Payment Details - Cheque

Please tick if you are forwarding a cheque:
	Cheque to be made out to: Knighton Heath Golf Club Ltd

Payment Details - By secure online portal

Please tick if you are paying through our secure online portal:
	Lloyds Bank

*Indicates a field you must enter.

Entry will only be confirmed upon receipt of payment

When you have completed the form, please click the SEND button below