REGISTRATION FORM - CONDOBOLIN 2025

Name of person completing this form *

First Name

Last Name

Member Details *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone Number

(###)

###

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Mobile Phone Number

(###)

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Parent/ Carer/ Emergency Contact 1 Name

First Name

Last Name

Emergency Number of Parent/ Carer/ Emergency Contact 1

(###)

###

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Parent/ Carer/ Emergency Contact 2 Name

First Name

Last Name

Parent/ Carer/ Emergency Contact 2 Details

(###)

###

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I give consent for the images of me/my child to be used in publicity for the club. *

Yes

No

I give consent for a trained first aid officer to administer first aid to me/my child if required. *

Yes

No

I give consent for an Ambulance to be called if deemed necessary for me/my child. *

Yes

No