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Junior membership application form

Welcome to our club. To help provide an efficient and enjoyable club for all our members, and to keep you up to date with club activities, we need some information about yourself. (This information will be held in our own database and handbook, and except in respect of our obligations of affiliation to the LTA will not be passed to any other organisation).

Please complete this form and then return it to the Membership Secretary:
Hazel Miller 253 Western Road, Leigh-on-Sea, Essex SS9 2QX (T 01702 558700).

Name (please print)		Date of birth: (optional)
Gender	Male / Female (delete as appropriate)
Contact numbers:	Home
	Mobile
Email address
Category of Membership	Junior (14-17) or Child(under14) or MiniTennisOrange or MiniTennisRed (delete as appropriate) (* see bottom of form for current subscription rates)

Parent/guardian details (essential if you are 17 or under):

Name (please print)
Relationship to child
Contact numbers:	Mobile
	Home
	Work
(if different from above) Address
Email address
Parent of Child Membership	Available to one or both parents at a special rate. Tick this box if you would like more information.

Note that membership applications will only be accepted when the appropriate money has been paid & accepted. Subscriptions run from 1st April to 31st March. Applications for joining during the year will be assessed pro rata. An acknowledgement will be provided on acceptance; this normally takes 7 days. We will also inform you of our coaching, competition and talent identification & development programmes.

Junior membership application form continued:

Please use this box to describe any special care needs, allergies or medical conditions (or any special dietary needs):

Applicant's signature:

Signed: ………………………………………………………… Date…………………..

If you are a British Tennis Member then please enter your number here:

Parent/guardian declaration

Please note that the club has adopted the Tennis Clubmark guidelines for Child protection, Equality and diversity, Codes of practice for parents/guardians/carers and young people and Health & Safety. These are on display in the clubhouse or readily available for inspection on request.

By signing and returning this form, I agree to ……………………………… (child's name) taking part in the general activities of the club, and to follow the rules of the club. I agree to accept the code of conduct for parents, and those Tennis Clubmark guidelines adopted by the club. I also agree that details may be forwarded to the LTA for British Tennis Membership (this membership is free).

For your information our coaches and volunteers have been advised to report any serious accidents or incidents to the LTA Child Protection: 0208 487 7008/7116.
The 24 hour line is 07971 141 024 www.LTA.org.uk/childprotection

To my knowledge there are no special care needs, allergies, medical conditions or dietary needs that could affect his/her 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, & to deal with the situation appropriately.

I understand that I must inform the club of any changes to the information provided on this form.

Parent/guardian signature:

Signed: ………………………………………………………… Date…………………..

Name: …………………………………………………………

* Current annual subscriptions are:
Junior(14-17):£97.20 Child(u14):£54.20 MiniTennisOrange:£29.20 MiniTennisRed:£17.70
Parent of Child:£18 (or £29 both)

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