2025 Canberra Club Enrolment form

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All members must complete the enrolment form to participate in classes

Are you a returning member or new to our club *

New to club

Returning member

Member's first name *

Member's Surname *

Date of Birth *

YYYY

Class Group joining (Your age is determined by how old you are on 31st August 2025 *

Fairies (3-4years)

5 years

6 years

7 years

8 years

9 years

10 years

11 years

12 years

13 years

14 years

15 years

1st year Senior (16yrs)

Seniors (17yrs +)

Ladies (18 years +)

Tuesday Bells

Parent/Guardian Contact Name (if under 16 years)

Contact email address *

Address *

Contact Phone Number *

Alternative Phone Number

Vikings Membership Number if you have one

I have/My child has an injury/health issue or allergy *

Yes

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