Chequers Netball Club Membership Form
Title *
First Name(s) *
Your answer
Surname *
Your answer
Date of Birth *
Your answer
Full Address *
Your answer
School / College
If applicable
Your answer
Email Address 1 *
Your answer
Email Address 2
Your answer
Home Tel
Your answer
Personal Mobile
Your answer
Parent's Mobile
Under 18's only
Your answer
If you do not wish your contact details to be shared with other club members please tick here
This is for Senior Squad members only
Ethnic Origin *
Required
DISABILITY *
Do you consider you to have a disability
If Yes to above, please state nature of disability
Your answer
MEDICAL CONDITIONS *
Do you have any known allergies or medical information that we should know about?
If Yes to above, please state nature of condition
Please provide details of medication that must be administered
Your answer
Do you have any past or current injuries that we should be aware of? *
If Yes to above, please provide all relevant details
Your answer
EMERGENCY CONTACT INFORMATION *
Please give name, relationship and a contact telephone number
Your answer
What section of the club are you from? *
If you are in the senior section, what team have you been selected for for the 2014/15 season?
Are you a new member of the club?
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