CLUB MEMBERSHIP FORM

Although not necessary for your first lessons, to speed up your membership process, please feel free to complete and print the whenever you are ready. All information is kept confidential and is not released to a third party.

GENERAL INFORMATION

SURNAME FORENAME
STREET
CITY POST CODE
TEL. NUMBER DATE OF BIRTH
OCCUPATION SCHOOL

HEALTH and SAFETY INFORMATION

Are you in generally good health? Yes No
Do you suffer from any of the following?(Tick as appropriate)
MIGRANE HEART
DIABETES ASTHMA
HAYFEVER NERVOUS DISORDER
HEMOPHILIA EPILEPSY
OTHER, Please specify
DOCTOR'S NAME DOCTOR'S CITY
DOCTOR'S TEL NO.