ࡱ> NPM'` bjbjLULU .(.?.?   4 VXXXXXX$h|| |  :  V V J  : 0q qq8  ||     ANNUAL YOUTH MEMBERSHIP APPLICATION & CONSENT FORM To be completed by a parent / guardian responsible for U18 members. Please complete and return this form to a club coach as soon as possible with the appropriate membership fee.ANNUAL FEES Adult - 75, Social - 35, Under 18 - 50, Under 15 - 45, Under 13 - 35, Under 11 25 Players who do not pay before end of June will be charged an additional 5. Players who do not pay before end of August will be charged a further additional 5. CHILDS DETAILS Childs name :____________________________________ Year just completed in school : ( Eg. P7, Year 9 )_______ Home address :____________________________________________________________________________________ Home tel no :_____________________________________ DOB : ____________________________ PARENT / GUARDIANS DETAILS Name :______________________________ Relation to child :________________________________ Mobile tel no :______________________________ Email address :__________________________________ I have read and signed the club documentation regarding the Child Protection Policy, U18 Code Of Conduct and Code of Conduct for Parent / Guardians Signed :_________________________________ Date :__________________ CONSENT AREAS ( only sign where you allow consent ) I grant permission for my child to attend and take part in the activities organised by Templepatrick CC. Signed :_________________________________ Date :__________________ I grant permission for my child to travel in a private car ( driven by a club member or other parent ) to and from matches. Signed :_________________________________ Date :__________________ I grant permission for my childs photograph or video image to be taken in relation to club activities. These images may be used for coaching, general publicity purposes, local press and on the club website. Signed :_________________________________ Date :__________________ MEDICAL DETAILS In order to provide the best care of your child, we need to be aware of any medical condition or allergies relative to them. Eg asthma, epilepsy, diabetic, allergy to penicillin etc. Please indicate below : ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ EMERGENCY CONTACT Please provide details of someone that can be contacted in case of emergency, other than named above. Name :_____________________________ Tel no :_____________________ Relation to child :____________________ $2345y   7 ;{og\TLD*CJaJhmH sH hCJaJmH sH jhU h3hhh3CJaJhhCJaJhhCJaJmH sH hhCJaJmH sH h5>*CJaJmH sH h5>*CJaJmH sH "hh ,5>*CJaJmH sH "hh5>*CJaJmH sH 45y`     gd Skd6$$Ifl0X `'X  t644 lal$If $$Ifa$gd3 $$Ifa$7 < = > K P Q Y Z \ _ ` ~     ) J N ] B ` a m , 5 9 D I [ b ôÜÜôÐÐÐÐÐÜwÄÄh5CJaJmH sH hCJaJmH sH h ,CJaJmH sH h3CJaJmH sH hCJaJmH sH h5>*CJaJmH sH hCJaJmH sH h5>*CJaJhih5>*CJaJhCJaJhCJaJhCJaJ. @ A B ` a - . $If ? @ $Ifekdt6$$Ifl'' t0644 la  c ,h3hCJaJmH sH hCJ aJ mH sH h5CJaJmH sH h5>*CJaJmH sH hCJaJmH sH  op$Ifekd6$$Ifl'' t0644 la!$Ifekdb7$$Ifl'' t0644 laa|YZdhekd7$$Ifl'' t0644 la,1h/ =!"#$% 6Dd L  C (ATCCLOGORp5(l֠ =L5D4FD5(l֠ =JFIFHHC     C   " }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?S(jZsj7PFOsq 8FY$a-߇3$l]=>e3`1FI- ׵#ᯃTy%["na0J`Gou_K_|Q's5}{{eymY #yJhrc#$#_3 (+=zR^[z J| l91ok ^=&`ʑfl6Q[~ҾeN0dQ_?7-߹ExT?ӄZtL, ot;yZ6GנdZ~S SgbxiaPp1h ( (kZZ[<#Eff<$IM#37>xb>!"fd,I H@_c`x-F_ c\65B4BB7v>)9O ]yq"0(^JV$8 8#>-$Gcί PiYF5s3\(VԔD63 //29S厔RpU)Tٵcg`)_ⓩA6ºǗz<`bX#gd&Oms~.=_A#/

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