Junior Membership Application
Season 2010/11
Enter 'None' if field not applicable, if you have any queries please leave a message on the Contacts page.
Team
* Age group (select) U6 U7 U8 U9 U10 U11 U12 U13 U14 U15 U16 U17 U18
* Managers name
* Managers Email
Player details
* First names
* Surname
* Address
* Post code
* Gender (select) Male Female
* Date of birth (ddmmyy)
* School
* Medical conditions
Agreement I have read and agree to abide by the rules of the club *
Parent/Carer
* First Names
* Parents Email
* Relationship
Emergency contact phone numbers
* Home
* Mobile
I understand that all subscriptions are non-refundable.
I agree to my child receiving any emergency dental, medical or surgical treatment including anaesthetic or blood transfusion as considered necessary by the medical authorities present
* Enter code (in blue)
