Safeguarding Form :: Burnham Beeches Golf Club

Burnham Beeches Golf Club

Dear Parent/Guardian,

Should your child suffer an injury or become ill whilst playing golf it may not always be possible to contact you. Should you not be available to give your consent at the time and wish Burnham Beeches Golf Club to provide First Aid, or seek emergency treatment, please complete the authorisation below and return it to Burnham Beeches Golf Club, along with the Entry Form.

Parent/Guardian
Name of Child or Young Person
Date of Birth
Doctors Name
Doctors Telephone No:
Doctors Address:
My child is under 16 years of age and I authorise Burnham Beeches Golf Club to arrange for my child to receive essential medical treatment from a qualified medical practitioner at a hospital, or other medical centre, if necessary.
My child is 16 years of age or over and I acknowledge that he / she has the right to decide for himself / herself on the treatment to be received or the need to attend a hospital or medical centre.
In the event of any medical attention being administered, I understand that Burnham Beeches Golf Club will inform me of the action/s taken.
Does your child experience any conditions requiring medical treatment and / or medication?

If YES then please give details, including medication, dose and frequency:-
Does your child have any allergies?

If YES then please give details
Does your child have any special dietary requirements?

If YES then please give details
What additional needs, if any, does your child have, e.g. needs help to administer planned medication, assistance with lifting or access, regular snacks? Please give details:
Please now record any medications which are NOT to be administered
I confirm that to the best of my knowledge my child does not suffer from any medical condition other than those detailed above.
I, being the parent / guardian of the above named child, hereby give permission for the Club’s responsible person to give the immediate necessary authority on my behalf, for any medical or surgical treatment recommended by competent medical authorities,
where it would be contrary to my child’s interest, in the doctor’s medical opinion, for any delay to be incurred by seeking my personal consent.
Signed (Parent / Guardian)
Date
Telephone Number
Work Telephone Number
PLEASE NOTE;- THIS FORM MUST BE COMPLETED. FAILURE TO DO SO WILL RESULT IN NON ACCEPTANCE OF ENTRY INTO THE COMPETITION
Confirm

Telephone 01628 661448
Burnham Beeches Golf Club, Green Lane, Burnham, Bucks, SL1 8EG

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