Junior Sport Membership

Please sign up for junior sport membership using the form below.

Parent or Guardian Name *

First

Last

Email *

Phone

Number of children you'd like to register?

Chosen number: 1

Child 1

Card Child team

Child 1 name *

First

Last

Child 1 sport *Choose a sport for Child 1Football – £195.00Rugby – £105.00

Choose a football team for child 1 *Under 6s FootballUnder 7s FootballUnder 8s FootballUnder 9s FootballUnder 10s FootballUnder 11s FootballUnder 12s FootballUnder 13s FootballUnder 14s FootballUnder 15s FootballUnder 16s FootballUnder 17s FootballUnder 18s Football

Choose a rugby team for child 1Under 6s RugbyUnder 7s RugbyUnder 8s RugbyUnder 9s RugbyUnder 10s RugbyUnder 11s RugbyUnder 12s RugbyUnder 13s RugbyUnder 14s RugbyUnder 15s RugbyUnder 16s RugbyUnder 17s RugbyUnder 18s Rugby

Does child 1 have any medical conditions? *

• Yes
• No

Please provide details of medical condition *

Child 2

Child 2 name *

First

Last

Child 2 sport *Choose a sport for Child 2Football – £195.00Rugby – £105.00

Choose a football team for child 2 *Under 6s FootballUnder 7s FootballUnder 8s FootballUnder 9s FootballUnder 10s FootballUnder 11s FootballUnder 12s FootballUnder 13s FootballUnder 14s FootballUnder 15s FootballUnder 16s FootballUnder 17s FootballUnder 18s Football

Choose a rugby team for child 2Under 6s RugbyUnder 7s RugbyUnder 8s RugbyUnder 9s RugbyUnder 10s RugbyUnder 11s RugbyUnder 12s RugbyUnder 13s RugbyUnder 14s RugbyUnder 15s RugbyUnder 16s RugbyUnder 17s RugbyUnder 18s Rugby

Does child 2 have any medical conditions? *

• Yes
• No

Please provide details of medical condition *

Child 3

Child 3 name *

First

Last

Child 3 sport *Choose a sport for Child 3Football – £195.00Rugby – £105.00

Choose a football team for child 3 *Under 6s FootballUnder 7s FootballUnder 8s FootballUnder 9s FootballUnder 10s FootballUnder 11s FootballUnder 12s FootballUnder 13s FootballUnder 14s FootballUnder 15s FootballUnder 16s FootballUnder 17s FootballUnder 18s Football

Choose a rugby team for child 3Under 6s RugbyUnder 7s RugbyUnder 8s RugbyUnder 9s RugbyUnder 10s RugbyUnder 11s RugbyUnder 12s RugbyUnder 13s RugbyUnder 14s RugbyUnder 15s RugbyUnder 16s RugbyUnder 17s RugbyUnder 18s Rugby

Does child 3 have any medical conditions? *

• Yes
• No

Please provide details of medical condition (copy) *

Total price

£0.00

Stripe Credit Card *

Card

Name on Card

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