Dorset County Golf Union

Dorset County

Golf Union

1923 - 2023

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The safeguarding of juniors in our care is a responsibility we take very seriously. As part of our commitment to child protection we ask parents and guardians provide vital contact and medical information so we can respond in any emergency situation that may arise. This information is stored in a secure area of this website and can only be accessed by persons appointed by the County Executive with a role to play in child protection.

Junior Name
Date of Birth
House Number & Street Name
Town / City
Post Code
Telephone Number
Parents' Name
Addresses (if different)
Home Phone
Mobile Phone
Work Phone
Email Address
Emergency Contact 1 Name
Relationship to child
Home Phone
Mobile phone
Work Phone
Emergency Contact 2 Name
Relationship to child
Home Phone
Mobile Phone
Work Phone
Please confirm details of all those with Parental Responsibility for the Child
Child's Doctor's Name
Doctor/ Practice Contact Number
Does your child experience any conditions requiring medical treatment and/or medication? Yes
No
If yes please give details, including medication, dose & frequency.
Does your child have any allergies? Yes
No
If yes please give details.
Does your child have any dietary requirements? Yes
No
If yes please give details.
What additional needs, if any, does your child have? Eg. needs help to administer planned medication, assistance with lifting or access, regular snacks?
Equality Act defines a disabled person: â€˜anyone with a physical or mental impairment, which has a substantial and long-term adverse effect on his/her ability to carry out normal day to day activitiesâ€™. Do you consider your child to have a disability? Yes
No
If yes, what is the nature of the disability?
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.
Consent from Parent/Legal Carer: 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 County of any changes to this information.
I give my consent that in an emergency situation, the county 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.
Medical Consent
I agree that my child has my permission to be on the premises where county activities are taking place.
I acknowledge that the county is not responsible for providing adult supervision for my child, except for formal junior golfing coaching, matches or competition.
I agree to my child being transported by county representatives to and from venues when he/she is representing the county.
Photographic Consent Yes
No

DCGU recognises the need to ensure the welfare and safety of all children in golf. As part of our commitment to ensure their safety we will not permit photographs, video images or other images of your child to be taken (except where some incidental inclusion may not be possible to avoid) or used without your consent.

DCGU will ensure that any image of a child where consent has not been obtained will not be published.

DCGU will follow the guidance for the use of images of children as detailed within the Safeguarding Children and Young Peoples Policy.

DCGU will take steps to ensure these images are used solely for the purposes for which they are intended i.e. the promotion and celebration of the activities of the county.

If you become aware that these images are being used inappropriately you should inform the County Welfare Officer immediately.

The photographs may be available on the website http://www.dcgu.org.uk for the current golf season. If at any time the parent/ carer or the child wishes the data to be removed from the website, 7 daysâ€™ notice must be given to the County Welfare Officer after which the data will be removed.

Full Name of Person giving Authority (I confirm that I have legal responsibility & I am entitled to give this consent and I am aware of how the information I have provided may be used).
Confirm

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