Name 1 (Parent / Guardian) *

First Name

Last Name

Name 2 (Parent / Guardian) *

First Name

Last Name

Name 3 (Juvenile) *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Name 4 (Juvenile)

First Name

Last Name

Date of Birth

Required for PPI Registration

MM

DD

YYYY

Name 5 (Juvenile)

First Name

Last Name

Date of Birth

Required for PPI Registration

MM

DD

YYYY

Phone (Family Contact) *

(###)

###

####

Would you like to be update about upcoming Club Competition, outings and updates? *

Updates will be made through the Club WhatsApp Group

Yes

No

Would you like to join our mailing list? *

Yes

No

Terms and Conitions

I hereby apply for membership of Poulaphouca Pitch & Putt Club and for membership of Pitch and Putt Ireland (PPI). I agree to comply with the rules of the Club. I agree to be bound by the rules of Pitch and Putt Ireland and I understand that my membership may be reviewed at any time. I understand that my personal information pertained above will be used by the Club to meet PPI registration requirements. I understand that if I do not provide my Personal Data, my membership cannot be registered with the Club and PPI. I understand that photographs may be taken during or at sport related events and may be used in the promotion of the sport. My child is in good health but I understand that it is my duty to advise Poulaphouca Pitch & Putt Club of any changes. In the event of illness, having a Parental / (legal) guardian responsibility, I give permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitably qualified medical practitioners. If I cannot be contacted and my child needs hospital treatment I authorize Medical practitioner to provide emergency treatment or medication I hereby consent to the above child participating in the Pitch and Putt activities of the Poulaphouca Club in line with the code of Ethics for young People. I confirm that all details are correct, and I am able to give Parental / (legal) guardian consent for my child to participate in any matches or pitch and putt event organised by the above Club and any other affiliated club and to be on any pitch and putt premises(clubhouse, course and practice area). I acknowledge however with this, that both the Club and others do not have responsibility for providing adult supervision for my child except for formal coaching and Competitions I further consent to my child: 1. Playing with older children / adults in County, Regional or National events. 2. Subject to my prior approval (which will be deemed to have been given in the absence of contact with the official in charge) travelling in the company of an Adult or Adults to an event in which the club or county is playing as a team or individually. 3. Receiving outdoor or indoor coaching or any other instruction from any club coach, county coach or National coach. 4. Receiving instruction or advice from any club or county officer or national official or any other authorised Representative. 5. Receiving such advice and instruction as may be considered to be reasonable in the circumstances from any club, county or national officer to protect the interests of my child whilst they are properly involved in any event organised by the club, county or national body in part or the whole. 6. Being included in any Team or Group photographs or being the subject of coaching and instruction by video. I understand that photographs may be taken during or at sport related events and may be used in the promotion of the sport.

I Agree