Junior Squash Application Form 2013
Parent First Name
Please enter parent first name
Parent Last Name
Please enter parent last name.
Junior First Name
Please enter junior first name
Junior last Name
Please enter junior last name.
Junior Birth Date
Please select the birth date of the junior
Any Medical Condition / Medication which may affect the junior.
Please specify any medical condition and/or medication which may affect your child.
Please enter mobile or landline phone number.
Please enter your E-mail address
Please enter your address
Please select the amount to be paid. This program is available to LLTC members only.
Squash only for existing LLTC members - €75
Squash and LLTC memebership until 31/12/13 - €105
How did you hear about us?
Please tick whatever way your heard about us from list below.
Word of mouth
Preferred time for coaching.
Please select your preferred time for coaching.
Saturday afternoon (after 2pm)
Thursday evening (after 4pm)
Please tick if you DO NOT want your child to be photographed/videoed
Photography or video during coaching sessions with your child in it maybe used by the club as marketing material on facebook, twitter, newspaper or the club website. Please tick the following box if you DO NOT want your child to be photographed.
I DO NOT want my child to be photographed/videoed
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