Mortonhall LTCFamily Membership
1st March 2016–28th February 2017
Name
Address
Telephone Mobile
All fees are due before 1stMarch2016
A late payment fee (£10) will be added to allsubscriptions received after this date.
Names / Date of Birth( Children ) / Email / Tel/Mobile / Subscription
£300
Key Deposit / £5
Late payment / £10
Cheques
Bank transfer / Made payable to Mortonhall LTC
Royal Bank of Scotland Sort Code 83-19-08 Account No 00200396 Your reference – Surname, Forename
Total
For security reasons Juniors and Minis cannot be issued with a clubhouse key. All requests for keys will be charged a deposit of £5 which will be reimbursed on return of the key.
Please send completed form and cheque to:
Sue Ramsahoye, 5 Albert Terrace, Edinburgh, EH10 5EA.
Tel: 0131 447 7600or 07787082155 / email:
by 1st March 2016
Keeping children and young people safe at the club is the responsibility of all Mortonhall club members. You are requested to read all Club Child Protection policies displayed through the Club Website or on Clubhouse noticeboards.
Please ensure that the parental consent form on page 2 of this application is completed and returned with your membership form,one form for each child.
We need you to complete this form at the start of every season and to let us know as soon as possible if any of the information changes.
Personal data
If you do not wish your email address or telephone number to be made available to other members of the club, either via email or via the club notice board, please tick this box.
British Tennis Membership Details. Please note membership of British Tennis is a requirement for any member competing in club competition or for any member wishing to apply for Wimbledon tickets through the club allocation. Registration can be obtained via this link
Parental Consent Details
Name of ChildDate of Birth
Parent/ Guardian:-
Address ……………………………………………………………………………………...…………………….
………………………………………………………...……...... …
Postcode ………………………
Tel (day): ……………………………......
Tel (evening): ………………………...... …………
Mobile: ……………………………………………………..
Email: ……………………………......
Family Doctor ……………………………………………
Doctor’s Tel No ………………………………......
Does your child suffer from any medical conditions/allergies that the club/ coach should be aware of (including any current medication)
………...…………………….………………………………………………………………………………..……
…...……………………………………………………………………..……………………………..…………..
Please provide details of medication that must be administered:
……………………………………………………………………………………………………………………..
…………………………………………..……………………………..……………………………..……………
Emergency contact details: (if different from above)
Name: ……………………………………………………………… Telephone no: ……………..…………
Relationship to child: ………………………………………………………………………………......
CONSENT (please read carefully)
a)I agree to my son/ daughter taking part in the activities of the club.
b)I confirm to the best of my knowledge that my son/ daughter does not suffer from any medical condition other than those listed above.
c)I consent to my son/ daughter travelling by any form of public transport, minibus or motor vehicle driven by a club coach or any other parent attending, to any event in which the club is participating.
d) I consent to the occasional use of photographs taken at events and matches which may include my son/daughter to be posted on the Club website.
e)I understand that the Club or Organisers accept no responsibility for loss, damage or injury caused by or during attendance on any of the clubs organised activities except where such loss, damage or injury can be shown to result directly from the negligence of the Club or the Organisers.
Signed …………………………………...... … (Parent/ Guardian)
Date: ……………………………