Laburnum Boat Club - Membership form
Laburnum Boat Club
Laburnum Street, London. E2 8BH
020 7729 2915    info@laburnumboatclub.com
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Email *
First Name *
Last Name *
Date of Birth
*
Use format dd/mm/yyyy
MM
/
DD
/
YYYY
Ethnic Origin
Gender
*
Address
Postcode *
Home Phone
Parent/Guardian Primary Contact E-mail
*
Parent/Guardian 1 Name
Parent/Guardian 1 Mobile
*
Parent/Guardian 2 Name
*
Parent/Guardian 2 Mobile
*
What school do you attend?
*
Does your child access Free School Meals?
*
Member Mobile
*
Emergency Contact Name (if parent/guardian is unavailable)
*
Emergency Contact Number
*
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