Hemel Hempstead Junior Squash Club - Membership Form
This form must be completed before any child (16 or under) can undertake any squash related activities on behalf of Hemel Squash Club at the Hemel Hempstead Leisure Centre
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What is your full name (this is to be completed by the Parent/Guardian)? *
What is your mobile phone number *
What is your child's full name? *
What is your child's DOB? *
MM
/
DD
/
YYYY
What is the member's address *
What is your relationship to the above child? *
In case of emergency, what is the name of someone else we could contact? *
What is the  mobile number for this emergency contact? *
Please provide details of any medical condition I should be made aware of regarding your child
Please provide details of any condition which requires medical treatment, including any medication the child requires
Session charge is £6 .

Do you agree with the above ? *
Payment is by Bank Transfer to :

20-92-60
90593478
Donald Luke

Payment also acceptable via PayPal:   PayPal.me/donaldluke

Which option will you be using?


 *
Which session(s)are you planning on attending? *
Required
Hemel Hempstead Squash Club recognises the need to ensure the welfare and safety of all young people in sport. In accordance with our child protection policy we will not permit photographs, video or other images of children or young people to be taken without the consent of the parents/carers and young person. I, the parent, consent to Hemel Squash Club photographing or filming my child in the involvement of squash for the purpose of publicising and promoting the club or sport or as a coaching aid  *
I agree to my child receiving medication as instructed and any emergency medical or surgical treatment including anaesthetic or blood transfusion as considered necessary by the medical authorities present *
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