Wufoo

Applicant Name
* First Last
This field is mandatory to identify your details
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Enter new address details
Home Phone Number

Enter new home phone number
Mobile Number

Enter new mobile number
Email

ENter new email address
Date Of Birth DD / MM / YYYY
Enter different date of birth
In case of duplicates just add 1 to day
Membership Type Required

Enter current membership type
Intended Method Of Payment

Enter new method of payment
Introduced by member First Last
If you were introduced by a current club member, please enter their name here, in order that they may claim their membership reward
ADDITIONAL DATA IN SUPPORT OF MINI OR JUNIOR MEMBERSHIP OR MINI GOLD MEMBERSHIP

Additional mandatory fields will be displayed if the membership type selected is Mini, Junior or Mini Gold
Mini Gold Application

Please enter the names of any children covered in a mini gold application
Parent / Guardian Name First Last
Enter new parent or guardian name
Relationship to child

Eg Mother / Father/ Guardian etc
EMERGENCY CONTACT NUMBER

This number will be used if the club has to contact you in case of emergency
Parent / Guardian email

ENter new parent or guardian email
ANY Medical, Dietary, or Allergy requirements the club should know about

Please detail any new special care needs, dietary requirements, allergies or medical conditions the club should be aware of regarding the applicant
Parent / Guardian declaration *
I understand and agree with the declaration to the right I need some help please contact me to discuss

I agree to the junior member applicant above, taking part in the general activities of the club. To my knowledge he/she has no special care, dietary or medical needs which could affect his /her safety at the club other than those declared on this form. I understand that in the event of injury or medical need the club will take all reasonable steps to contact me at the emergency contact number and deal with the situation appropriately.
Photography & Promotions *
I authorise the club to possibly take photos of my child in club activities I do not wish any photos to be taken of my child

Blaydon TC complies strongly with child protection law and policies. We sometimes take photos of events at the club which may be used for promotional purposes or published on the club website to record and recognise achievements. Please let us know if you authorise the club to take and use pictures of your child for these purposes
Old Post Code *

Enter the last post code used for your details to help us find you, to make the required changes
Do Not Fill This Out

Wufoo

ADDITIONAL DATA IN SUPPORT OF MINI OR JUNIOR MEMBERSHIP OR MINI GOLD MEMBERSHIP