Renzoku Judo Membership Form

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Personal Information & Contact Details
Name

First NameLast Name
Address
Post Code
Email
example@example.com
Phone Number (land line)
Mobile Number
Gender, Age & Date of Birth
Age
Date of Birth

DayMonthYear
Date
Gender
Parent / Guardian Details (if Applicable)
Parent / Guardian Name

First NameLast Name
Phone Number Parent / Guardian (land line)
Mobile Parent / Guardian
Ethnicity and Disability
Ethnicity
Disability (if Applicable)

Other
General Data Protection Regulation ("GDPR")

To help comply with GDPR consent requirements, effective from 25th May 2018, we need to confirm that you would like to receive information from us. If you'd like to continue hearing from us, please sign below:
Signature
Date GDPR acknowledgement

DayMonthYear
Date
Declaration

If my child becomes injured and requires treatment, I consent to first aid treatment being administered. This includes requesting an Ambulance.
Signature
Date signed Declaration

DayMonthYear
Date
Relationship to Child
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