Application Form for New Junior Members

Required field

Junior's First Name *

Junior's Family Name *

Date of Birth *

CDH Number (if they have one)

If your Junior have been a member of a previous club, please contact them for their CDH number and for them to log your Junior as 'AWAY'. If your Junior does not have a CDH - don't worry, just leave this blank

Address *

Junior E-mail (parent will always be copied) *

Junior Mobile Number

junior Home Phone

Parent/s name *

Parent/s address (if different)

Contact number/s Mobile *

Contact number/s Home Phone *

Contact number/s Work Phone *

Emergency contact 1: Name and best number to contact them on *

Emergency contact 2: Name and best number to contact them on *

Please confirm details of all those with Parental Responsibility for the Child. *

Doctor's name, surgery and telephone number *

Does your child experience any conditions requiring medical treatment and/or medication? *

If yes, please give details

Does your child have any allergies *

If yes, please give details

Does your child have any specific dietary requirements? *

If yes, please give details

The Equality Act 2010 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 child to have a disability? *

If yes, please give details

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 them to communicate with us fully. *

I confirm to the best of my knowledge that my child does not suffer from any medical condition other than those detailed above. *

I agree to notify the Club of any changes to this information. *

Car they will arrive in - brand, Colour and Registration

Starting Month *

Please select your desired membership package *

All prices inclusive of VAT, admin charges, affiliation fees and insurance.

Term of Contract *

I am making a lump sum annual payment

Would you like a locker for convenience? *

I plan to pay by *

Due to social distancing policy, our strong preference is for you to pay by bank transfer or standing order, clearly referencing your name.
All bank transfers and standing orders to Lloyds Bank 30-14-71 A/C 16881168. Cheques to PRGolfClub.Com Ltd. Thank you.

I give my consent that in an emergency situation, the club may act in my place (loco parentis), if the need arises for the administration of emergency first aid and/or other medical treatment which, in the opinion of a qualified medical practitioner, may be necessary. I also understand that in such an occurrence all reasonable steps will be taken to contact me or the alternative adult named in this form. *

My sending this e-form to PRGC denotes that my child has my permission to be on the golf club’s premises. *

I acknowledge that the club is not responsible for providing adult supervision for my child, except for formal junior golfing coaching, when they are under the responsibility of the PGA Pro *

Sending this e-form is the equivalent to signing this document and I confirm that I have legal responsibility for this Junior *

Message

Next steps... *

Important: 1) When sending this form you are giving consent to receiving golf club related emails from time to time 2) Your membership becomes valid when your payment has been received

Mansoor

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