2025 Club Membership

Athlete Medical Details
Additional Emergency Contact*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.
YesNo
YesNo
Please list any relevant information below:*
Eg. Allergic to bandaids.
YesNo
Please list any relevant information below and course of action:
eg: fractured toe, off the foot for 2 weeks

Payment
Direct debit fortnightly (incurs additional fees)Direct debit monthly (incurs additional fees)Pay per term upfrontPay full year upfront (5% discount)
Athlete Signature*

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Parent/Guardian signature

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