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Laburnum Boat Club - Membership form
Laburnum Boat Club
Laburnum Street, London. E2 8BH
020 7729 2915 info@laburnumboatclub.com
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* Indicates required question
Email
*
Your email
Young person's First Name
*
Your answer
Last Name
*
Your answer
Date of Birth
*
Young person must be over 9.
Use format dd/mm/yyyy
MM
/
DD
/
YYYY
Ethnic Origin
Choose
Asian: Bangladeshi
Asian: Indian
Asian: Pakistani
Other Asian
Black: British
Black: Caribbean
Black: African
Black: Congolese
Black: Nigerian
Black: Somalian
Black: Other
Bi-Racial: White Asian
Bi-Racial: White Black African
Bi-Racial: White & Black Caribbean
Bi-Racial: Other bi-racial background
White: Irish
White: British
White: European
White: Albanian
White: Kosovan
White: Turkish
White: Turkish Cypriot
White: Other
Other: Chinese
Other: Fillipino
Other: Iranian
Other: Iraqi
Other: Kurdish
Other: Latin South American
Other: Moroccan
Other: Other background
Gender
*
Male
Female
Prefer not to say
Other:
Address
Your answer
Postcode
*
Your answer
Home Phone
Your answer
Parent/Guardian Primary Contact E-mail
*
Your answer
Parent/Guardian 1 Name
Your answer
Parent/Guardian 1 Mobile
*
Your answer
Parent/Guardian 2 Name
*
Your answer
Parent/Guardian 2 Mobile
*
Your answer
What school do you attend?
*
Your answer
What borough is your school in?
*
Your answer
Does your child access Free School Meals?
*
No
Yes
Other:
Required
If yes to FSM, please state which borough and your code
Your answer
Member Mobile
*
Your answer
Emergency Contact Name (if parent/guardian is unavailable)
*
Your answer
Emergency Contact Number
*
Your answer
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