Professional Documents
Culture Documents
Membership Form PDF
Membership Form PDF
___________________________________________________
Address:
________________________________________________
Surname
First
Other Names
________________________________________________
Email:
________________________
Phone:
_______________
_______________
Home
Cell
Religion:
Month
Year
________________________________________________
First
Contact:
______________________________________________
Next of Kin:
______________________________________________
Contact:
______________________________________________
Work
Home
Surname
Mobile
First
Work
Home
Mobile
First
_________________________________
Relationship to Member
Sport interest(s):
[ ] Aerobics
[ ] Karate
[ ] Track
[ ] Basketball
[ ] Cricket
[ ] Football
[ ] Netball
[ ] Swimming
[ ] Tennis
[ ] Other_______________________________________
Culture interest(s):
[ ] Chorale
[ ] Other_______________________________________
Community interest(s):
[ ] Volunteering
[ ] Homework Club
[ ] Book reading club
[ ] Other_______________________________________
Christ interest(s):
[ ] Outreach
[ ] Other_______________________________________
MEDICAL HISTORY
Please state any medical conditions and/or allergies that we should be aware of:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Please provide details of medication that must be administered:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Please state any past or current injuries that we should be aware of:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Family Doctor:
______________________________________________
Telephone No:
_____________________________________________