Min age for U6: Child must be 4 years old on Jan 1st this year.

Parent /Guardian information - (1 form per family required) Parent/Guardian A Name Mobile phone Email address Address Home Phone number I am a qualified first aider and willing to help out with my Childs team.

Parent/Guardian B

1. Yes & Can help Regularly 2. Yes & Can help Occasionally 3. No

1. Yes & Can help Regularly 2. Yes & Can help Occasionally 3. No Yes / No Yes / No Yes / No Player Information (U6 - U16) Player 2 Yes / No Yes / No Yes / No

I am willing to help with events and activities during the year I am or would be interested in becoming a coach or adminisstrator in the club. I consent to my childs picture(s) being used in news items relating to Ballina GAA club Player Info Name - English Player 1

Player 3

Player 4

Name - Irish

Gender Male / Female Date of birth Age group U6-U16 *see below Does your child have any medical conditions relevant to sporting activity ?

Male / Female U__

Male / Female U__

Male / Female U__

Male / Female U__

1. FULL Adult Membership only (Including Youth / Student)

Full Membership Option 1: 1 x Full Adult / Youth Membership Full Membership Option 2: 2 x Full Adult / Youth Membership Full Membership Option 3: 3 x Full Adult / Youth Membership Full Membership Option 4: 4 or more x Full Adult / Youth Membership Membership Rate 45 80 95 45 80 100 120 Family Contribution 25 25 25 TOTAL DUE 70 105 120

Tick as Appropriate

2. Juvenile Club Membership (U6-U16 Children only + Familty Contribution*)

Juvenile Club Membership Option 1: One Under 18 / Student * Friends of Ballina & Buy A Sod contributors do not need to pay 25 Family Contribution. Juvenile Club Membership Option 2: Two Under 18s / Students Juvenile Club Membership Option 3: Three or more x Under 18s / Students)

3. Family Membership (Parents + All Children including U18s & students)

Family Membership Option 1 (2 x Adults & 3+ x Under 18's / students) Note: Subsidised rates available to qualifying FOB members (free adult OR reduced child membership) Note: When registering U6-U16 children, you can either choose one of the 6 family membership options or a juvenile membership only (this incurs a 25 family contribution). Family Membership Option 2 (2 x Adults & 2 x Under 18's / students) Family Membership Option 3 (2 x Adults & 1 x Under 18 / student) Family Membership Option 4 (1 x Adults & 3+ x Under 18's / students) Family Membership Option 5 (1 x Adult & 2 x Under 18's / students) 145 120 95 120 95 80 145 120 95 120 95 80

Family Membership Option 6 (1 x Adults & 1 x Under 18 / student) I have read and discussed the clubs Code of Ethics, Conduct, and Practice with my child (code available from club website). www.ballina.tipperary.gaa.ie Club Website Payment Received Membership Fee FOB / Buy a Sod Discount (if applicable) Total Club Official signature

Parent / Guardian Signature Date

( )

Note: 1. A copy of this form is available on the club website. 2. Hurleys & club merchandise can be purchased in the club shop. 3. Helmets are available at a SUBSIDISED COST of 45 (Small/Medium). U-6/ 2008-2009 U-8/ 2006-2007 U-10/ 2004-2005 U-12/ 2002-2003 U-14/ 2000-2001 U-16/1998-1999

Age Groups / year of birth