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: ………………………………………………………………………………………………………………………………...

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

PLAYER’S E-MAIL (senior players only): ……………………………………………………………………………………............
MOBILE (senior players only): …………………………………………………………………………………………………...........

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:
 
PARENT/GUARDIAN CONTACT NUMBERS

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

NAME: ……………………………………………………….. TEL: ………………………………………………………........
 
SCHOOL ATTENDED: ……………………………………………………………………………………………………………….
 
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)

 ………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………….
By returning this completed form, I agree to the child in my care taking part in the activities of the club. I understand that I will be kept informed of these activities – for example timings and transport details. I understand that in the event of any injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately.

Name of parent /guardian: ……………………………………………………………………………………………………..

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