Junior Membership Form
Player’s Details
…………………………………………………...............
…………………………………………………...............
…………………………………………………...............
…………………………………………………...............
Postcode:
…………………………………………………...............
Date of Birth:
…………………………………………………...............
Home Tel:
…………………………………………………...............
Parent(s) Mobile: …………………………………………………...............
Current School: …………………………………………………...............
Current Year:
…………………………………………………...............
Name:
Address:
Additional Information
Next of kin/contact in the event of injury ……………………………………………
Tel: ………………………...........................................
Does the player named on this form have any medical conditions, allergies or particular issues that
the Club should be aware of in case of injury or illness whilst playing for the Club? (if yes please give
details)
……………………………………………………………………………………………….
……………………………………………………………………………………………….
CLUB COMMUNICATIONS ARE BY EMAIL – PLEASE PROVIDE AN EMAIL ADDRESS BELOW
The club would like to be able to pass on your telephone number to other team members (if required)
so that transport and travel to matches and events can be easily arranged and shared between
players. This is not to produce a list for general distribution.
The Club would also like to be able to use photographs / video recordings for training (skills analysis)
and public relations purposes (website / press articles etc.).
Do you consent to the following:
Medical treatment being administered in an emergency?
Your contact details being shared as described above?
Photographs / video recordings being used as described above?
Club officials transporting the named player in their own car?
Y/N
Y/N
Y/N
Y/N
As a parent / carer are you willing to assist the club in any of the following areas?
Fundraising
Y / N
Help on Match Days
Y / N
Umpiring / Scoring / Both (delete as appropriate)
Y / N
Ground Maintenance
Y / N
Coaching
Y / N
Occasional Help (e.g. Fun Run steward, painting the pavilion)
Y / N
Signed: ……………………………… (Parent / Carer)
Date: ………………………..
Kirsteen Ross, Club Secretary, 15 Springfield Park, Kinross, KY13 8QS 07740 676104 email: [email protected]
Kirsteen Ross, Club Secretary, 15 Springfield Park, Kinross, KY13 8QS 07740 676104 email: [email protected]