New Joiner Registration

Contact Information

Last Name *

First Name(s) *

Primary Email Address *

Alternate Email Address

Type of Membership:

Senior Junior

Mobile Phone *

Postal Address

Date of Birth

Disability & Medical Information

Disability & Medical Information

Emergency Contact

Contact Name

Contact Phone Number

Contact Email Address

Notes for Parents / Guardians

By submitting this completed form:

I agree to my child taking part in the activities of the Club including away fixtures.
I understand that I will be kept informed of these activities, for example timing and transport details.
I understand that in the event of injury or illness, all reasonable steps will be taken to contact me and to deal with that injury / illness appropriately. In the event of the Club being unable to contact me, I give consent for the Coach or First Aid Officer to act on my behalf.
I have read and agree with the Commitment to Safeguarding Young People adopted by the Club.

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