If registering more than one person, please enter the name of the lead member first.
MEMBER DETAILS
First name
*
Last name
*
Gender
Select
Male
Female
Date of birth
Day
1
2
3
4
5
6
7
8
9
10
11
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18
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28
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30
31
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
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1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
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1980
1979
1978
1977
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1974
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1971
1970
1969
1968
1967
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1965
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1963
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1961
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1952
1951
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1949
1948
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1945
1944
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1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
Age
Address 1
Address 2
Address 3
Town
County
Post code
Please detail any medical information, allergies or injuries that the club should be aware of
The Club aims to encourage community participation in the sport. In order to help the Club monitor its membership we ask you complete the following Ethnicity question.
PARENT / GUARDIAN SECTION
Parent / Guardian first name
Parent / Guardian last name
Home phone number
Mobile phone number
Email address
*
Verify email address
*
The Club is partly financed by sponsorship which is an important part of our success. If you think that you, or your contacts may be able to assist the Club please indicate below.
Potential sponsor
DECLARATIONS
In the event that the above named member is injured whilst in the care of the club:
Select
I give consent for medical treatment to be administered
I do not give consent for medical treatment to be administered
Photographic Consent
Images of members under the age of 18 will never be identified or named without parental consent and will only be used in accordance with the Clubs child protection/photography policies and Best Practice guidelines.
Photographic consent
Select
I consent
I do not consent
I will abide by the Club's constitution, club rules, code of conduct, disciplinary policy, equity policy, social networking and child welfare policy. I understand that if the above named member does not also abide by these rules / codes of conduct / policies that the club may take disciplinary action.
Select
I agree
I disagree
Date added
2005 GROUP A
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