Juvenile Application Form - Coollattin Golf Club

Junior Membership is open to young people whose age shall not be less than 10 years or more than 18 years.

The safety and welfare of Junior members, when in our care, is paramount, and it is therefore important that we are aware of any illness, medical condition and other relevant health details so that their best interests are addressed.

Please complete this form with our assurance that the information will be treated as CONFIDENTIAL.

Before submitting this form, we ask that you become familiar with the Regulations for Junior Members.

IMPORTANT:- This form must be submitted by a parent / guardian of the junior applicant.

Full Name of Junior *

Date Of Birth of Junior *

Is The Junior Applicant Male or Female? *
MaleFemale

Full Name of Guardian / Parent *

Phone Number of Guardian / Parent *

Email Address of Guardian / Parent *

Phone Number of Junior (if applicable)

Email Address of Junior (if applicable)

Address of Junior (including Eircode) *

Emergency Contact Details:

Emergency Contact 1

Name *

Relationship To Child *

Contact Number *

Address of Emergency Contact *

Emergency Contact 2

Name *

Relationship To Child *

Contact Number *

Address of Emergency Contact *

Medical Information:

Applicant's Doctor's Name *

Telephone Number of Doctor's Surgery *

Doctor's Surgery Address *

Medical History Information *

Please include all medical details that might be relevant in dealing with your child in a safe manner, such as allergies, medication, special needs etc.

Contacts:

The Clubs “Junior Convenor” and “Child Protection Officer” can be contacted through the Club Office at 053 94 29125

Parent / Guardian Consent:

To submit your application, you must agree to all of the statements below

I hereby consent to the named applicant participating in golf activities at Coollattin Golf Club in line with the Club’s Code of Ethics for Golf for Young People and the Club’s Regulations for Junior Members.
I will inform the leader of any changes to the information provided above. I confirm that all the details are correct, and I can give consent for my child to participate in and travel to all activities.
I understand that photographs will be taken during or at golf related events and may be used in the promotion of golf.
I acknowledge that the club is not responsible for providing adult supervision for my child except at formal events and junior golf coaching, matches or competitions.

By using this form you agree with the storage and handling of your data by this website.

Junior / Juvenile Membership Application Form

Emergency Contact 1

Emergency Contact 2

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Junior / Juvenile Membership Application Form

Emergency Contact 1

Emergency Contact 2

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