BROOKFIELD LAWN TENNIS CLUB, PALMERSTONPARK, DUBLIN 6

Application for Junior Membership 2017

(Please return completed form and payment to: Honorary Secretary, Brookfield LTC, PalmerstonPark, Dublin 6 4974168)

PERSONAL DETAILS (Block Capitals)

Name______

Address______

______

Phone(Home) ______(Work)______(Mobile) ______

Email______Date of Birth ______

TENNIS HISTORY

School Experience ______TSB Grade/ITN______

Name of School ______School Team Yes / No

Junior LeagueExperience Yes / No If Yes, state level ______Have you had CoachingYes / No

Participation in Open Tournaments ______

______

Have you previously applied for Membership of Brookfield?Yes / NoYear ______

Are you a member of another club?Yes / NoClub______

Have you been a member of another club?Yes / NoClub______

Do you want to playCompetitive Tennis / Social Tennis / Both

Would you be prepared to represent Brookfield?Yes / No Are you interested in receiving coaching? Yes / No

MEMBERSHIP CATEGORY APPLIED FOR

B1Junior Tennis Member (14 and over and Under 18 on 01/01/17)Subscription: €175

B2Junior Tennis Member (7 and over and Under 14 on 01/01/17)Subscription: €175

FINANCIAL DETAILS

I enclose a Cheque/Bank Draft (made payable to Brookfield LTC) for €175 as my first Annual Subscription. This will be returned in the event of non-election. If elected, I agree to comply with the Rules and Regulations of the Club.

Signature______Date______

PROPOSER & SECONDER

I, the undersigned, confirm that the above Applicant is personally known to me and I am prepared to recommend him/her for Membership of Brookfield LTC. I undertake to introduce him/her to two members of the Committee before election, if required to do so, and, if elected, introduce him/her to the Club.

Proposer Name ______Signature______

Seconder Name ______Signature______

DECLARATION TO BE COMPLETED BY THE APPLICANT’S PARENT / GUARDIAN

I ______being the Parent / Guardian of ______undertake that I will be responsible for the behaviour of the above named, if elected, at all times that he/she is on the Club premises and will ensure that he/she complies with the Club Rules and Regulations. I further agree that the Applicant will not be allowed to attend the Club except under the Club’s Rules and Regulations. (Please see over for Child Protection Policy Statement)

Signed______Date______

PLEASE TURN OVER

BROOKFIELD LAWN TENNIS CLUB, PALMERSTONPARK, DUBLIN 6

Child Protection Policy Statement

Brookfield Lawn Tennis Club (the Club) is fully committed to safeguarding the well-being of its members. Every individual in the Club should at all times show respect and understanding for their rights, safety and welfare, and conduct themselves in a way that reflects the principles of the Club and the guidelines contained in the Code of Ethics and Good Practice for Children’s Sport.

Notes on applying for Junior Membership

  1. It is a strict requirement of Membership that a Cheque/Bank Draft for the appropriate Subscription is enclosed with the Application. The Committee will not consider an Application without this. Discounts, as in 8 below, do not apply to the First Annual Subscription of any member.
  1. Proposer and Seconder must be Senior Tennis Members or Pavilion Members who have been Senior Tennis Members. They cannot be members of the same household.
  1. Where more than one Application is received from the same family, Applicants are requested to state order of preference for election.
  1. Successful Applicants are required to familiarise themselves with the Rules and Regulations of the Club. A copy will be forwarded with confirmation of their election. In particular, Applicants are reminded that only recognised tennis clothing and footwear may be worn on court.
  1. An Application for Junior Membership will not be considered unless the Declaration is completed by a Parent/Guardian. Please state if Parent(s), Guardian(s) or Sibling(s) are current members.
  1. For 3 or 4 playing Members (A1,A2,B1,B2) in one family, there is a 15% discount on total subscription.

For 5 or more playing Members (A1,A2,B1,B2) in one family, there is a 20% discount on total subscription.

The discount does not apply to Pavilion Subscriptionsor the First Annual Subscription of any member.

PLEASE RETAIN THIS PAGE FOR INFORMATION PURPOSES. DO NOT SEND WITH APPLICATION