2019-2020 Membership Form
For Under 18's - The membership forms/process needs to be completed by a person with parental responsibility on behalf of the child.
Player information
First name(s) *
Your answer
Surname *
Your answer
Is the young person known by a different name from above?
Your answer
Date of birth *
MM
/
DD
/
YYYY
Address *
Your answer
Post Code *
Your answer
Home phone number *
Your answer
Tee-shirt size (adult sizing) *
Name of school
Your answer
School year
Email address *
Please enter email addresses you would like to be contacted on. You can have them sent to as many addresses as you like (preferably at least one parent and one player); to enter more than one, please separate with a comma.
Your answer
Image disclamer
From time to time members may be filmed (including video and photographic images) whilst taking part in activities for publicity or training materials.
Image disclamer *
Please tick the box to confirm you agree with the above statement
Required
Emergency Contact and Medical Information
I agree to my child raking part in the Dorset Storm Basketball Club, which will involve him/her in coaching, playing, or competitive activities. I authorise the Lead Coach/Team Manager of the activities or team to give consent on my behalf allowing my son/daughter to receive medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion on the advice of a medical practitioner.

I set out below, details of any medical conditions from which my son/daughter is suffering, together with details of any treatment and medications currently being taken. I undertake to immediately notify the organisers of any changes to the notified medical status/conditions.

Please tick the box to confirm you agree with the above statement *
Required
Relevant medical details
Please provide any medical conditions from which your son/daughter is suffering, together with details of any treatment and medications currently being taken. Further information such as particular dietary requirements or cultural issues that will help us to ensure your child will be able to take part in activities can also be included.
Your answer
Contact information in case of emergency *
Please include: 1) the name to ask for when calling, 2) their relationship to the young person and 3) their telephone number
Your answer
Name of person completing form and relationship to young person *
By clicking on submit you confirm that to the best of your knowledge the information on this form is accurate.
Your answer
Submit
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