Entry form: Disabled British Open 2019 Stratford Park 21st-23rd August - dbo2019.com

COMPLETE IN BLOCK CAPITALS

Full name:

Nationality:

Home address:


 

Postcode:                           Phone number:                                           Email:

 

 Entry Fee £ 25.00 

 Extra Dinner Tickets:  Number       @ £25.00


 

CONGU competition handicap or CONGU Club Handicap

or Slope-based Home club competition handicap

CDH (Central Database of Handicaps or equivalent) number:

Disability/Impairment:

Buggy Required: Is a buggy a necessity in order to participate in the day?   Yes / No

Arrival/ Departure Date:  

                                                                                           

Signed:                                                                                              Date:


 

By signing the entry form I consent to any press and television reports, photographs or publicity which may be published in connection with my participation in this event. By signing the entry form I also confirm that I carry insurance for third party liability and absolve the organisers and sponsors from any liability for any damage or injury caused by me, my family or friends whilst attending the event.

CHECK LIST Please ensure you complete and send the following items:

   Pay Entry fee -  to

                        The Handigolf Foundation

                                      Reference: DBO 2020

                                      Lloyds Bank

                        sort code 30-95-43

                        Acc no. 33091668                                                                   IBAN GB76 LOYD 3095 4333 0916 68 

   

 Copy entry form confirming payment to philmeadows70@icloud.com


 

Entry form (continued) ESSENTIAL INFORMATION for HEALTH & SAFETY(Confidential)

 

Mindful of the welfare of our competitors, all players wishing to play in our event must complete the essential information form below and return it with your entry form.

This will only be used in cases of an emergency; failure to complete this form will result in a player not being able to compete in our tournament.

 

Full name: Date of Birth:

Disability:

 

Current Medication:

 

 

Any health needs:

 

Name and address of GP:

 

 

 

In an emergency please contact:

 

Name:

Home Phone number:

Mobile Phone number:

 

Relationship to you:

 

DISCLOSURE: Except in an emergency this information is NOT to be given to a third party without my consent.

 

 

Signed:                                                                                Date:

 

Note: The above medical data will be deleted once the competition has completed