DUNSHAUGHLIN PITCH AND PUTT CLUB

APPLICATION FOR MEMBERSHIP (Adult/Family)

 

NAME................................................................P&P H’CAP (if any)......................

ADDRESS..........................................................GOLF H’CAP (if any)...................

 

 ................................................................AGE (if under 16)..........................

 

................................................................PHONE NO................................... 

What clubs or societies have you been a member of? Golf or P & P. 

.................................................................................................................................... 

Have you been registered with the Pitch and Putt Union of Ireland?

 

....................................................................................................................................

Give the registration number if known.

If family membership is required please supply the relevant information below. Include

dates of birth of all juveniles between the ages of eight and fifteen inclusive.

Spouse.......................................................................................................................... 

Children.............................................................................Date of birth...................... 

            ...............................................................................Date of birth...................... 

            ...............................................................................Date of birth.....................

Annual subscriptions               Ladies or Gents           €80 Husband and Wife      €140  *Family  €150

                                              Student €35  Juvenile  €25  Senior  Citizens €50                                                                       

*family embership covers husband and wife and juveniles 8 to 15 years inclusive.

 

Signed_________________________________________________         

                                                                       

 

                                                                        Private & Confidential

 

DUNSHAUGHLIN PITCH & PUTT CLUB

                                                                                                     

Application for Juvenile Membership

Name:                                      ________________________________________________

Address:                                  ________________________________________________

                                                ________________________________________________

                                                ________________________________________________

Date of Birth:                          ________________________________________________

Parent/Guardian Name(s):      ________________________________________________

Phone Number:                       ________________________________________________

Phone Number in case of emergency: _________________________________________

GP’s Name:                             ________________________________________________

Telephone Number:                 ________________________________________________

Please indicate below if your child suffers from any of the following:

  • Respiratory problems:________________________________________________

    Allergies:___________________________________________________________Any other medical condition_____________________________________

As a result of this he/she requires the following attention/medication:

            __________________________________________________________________ 

            __________________________________________________________________

Parent’s/Guardian’s signature:________________________________________________

Date:   __________________________________________

Agreement for Medical Treatment

I hereby consent to _______________________(child’s name) receiving medical treatment if a doctor thinks it is required in an emergency after reasonable attempts to contact me have failed.

Parent’s/Guardian’s signature:__________________________  Date:_________________

Juvenile fee €25 (age 8 –15)

 

 

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