TRACKSIDE LAWN TENNIS CLUB
MEMBERSHIP FORM 2017
If you wish to become a member of Trackside Lawn Tennis Club, please complete and return this form with payment to Fiana O’Hanlon, Membership Secretary.
Cheques should be made payable to Trackside Lawn Tennis Club
Surname / First Name / Age & D.o.B. if under 18 / Gender / Annual Subs(see below)
€
€
€
€
€
€
Total / €
Membership
Type / Definition / Annual
Subs*
Senior / €120
Family** / €160
Junior / Age 8 to 17 on 1st February of the membership year / €35
Student / Age 18 and over on 1st February of the membership year and in full time education / €50
Notes:
- *Year runs from 1 February 2017
- **Family membership is limited to 2 adults and school going children under 18
- Annual subscriptions are not refundable and waivers are not permitted
- All members must abide by the Constitution and Rules of the Club
Signature: Date:
Name:
Address:...... Home telephone......
...... Mobile......
...... E-mail......
As a club we will correspond with you via the main email address supplied. Please tick if you do not wish to be included on the club mailing list
Please enter details of all members under the age of 18 (all members must be living at the same address)
Name: / Gender: / Date of birth:Contact number: / Email
Please enter any special care needs, dietary requirements, allergies or medical conditions that the club needs to be aware of:
Name: / Gender: / Date of birth:
Contact number: / Email
Please enter any special care needs, dietary requirements, allergies or medical conditions that the club needs to be aware of:
Name: / Gender: / Date of birth:
Contact number: / Email
Please enter any special care needs, dietary requirements, allergies or medical conditions that the club needs to be aware of:
Please provide Emergency contact details for all members under 18:
Emergency contact 1...... Emergency contact 2......
Contact details......
Parent/Guardian Declaration (for all members under 18 years of age)
I agree to all U18 members on this form taking part in the general activities of the Club in line with the Code of Ethics for Tennis.
To my knowledge the U18 members have no special care needs, dietary requirements, allergies or medical conditions that could affect their safety at the Club, other than those declared on this form. I understand that in the event of any injury, illness or other medical need, all reasonable steps will be taken to contact me.
Video equipment may occasionally be used as a performance coaching aid and/or photographs taken for use in tennis publicity or publication.
I am happy for the under 18 members to be videoed/photographed.
Yes No
Signed...... Date......
Name...... Relationship to member(s)......
I have read and subscribe to the Club's policy on Child Protection. The policy is available on the Club website - - and is also on display in the Clubhouse.
Signed by Senior Member or Parent/Guardian......
Print Name...... Date......