Membership Form

Rudgwick Netball Club

Lead Coach: Emily King
Tel: 07799 514954 e-mail: emilylouiseking@btinternet.com
Please make a note of contact details above in case you need to contact us.

NAME OF PLAYER: .………………………………………………………………………………………………………………….....
 
DATE OF BIRTH: ……………………………………………………… Age ………………………………......
 
ADDRESS: ………………………………………………………………………………………………………………………………...

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HOME TEL: …………………………………………………………………………………………………………………………….....
 
PLAYER’S E-MAIL: ……………………………………………………………………………………..........................................

MOBILE: ………………………………………………………………………………………………….........................................

Filling in this information is optional. It is for record keeping purposes only:

ETHNIC ORIGIN: White ( ) Mixed ( ) Asian or Asian British ( ) Black or Black British ( ) Chinese or other ethnic group ( )

IN CASE OF EMERGENCY:
 

NAME: ……………………………………………………….. TEL: ………………………………………………………........

NAME: ……………………………………………………….. TEL: ………………………………………………………........
 

 PREVIOUS NETBALL EXPERIENCE: ……………………………………………………………………………………………..

HEALTH INFORMATION
Please detail below any important medical information that our coaches should be aware of eg. epilepsy, asthma, diabetes etc. including any current medication and known allergies.
YES / NO (if YES please provide details)

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Signature: ………………………………………………… Date: …………………………………………………….........