Membership form (click here to download)

 

Woodthorpe Huffers and Puffers

 

We are very pleased to welcome you to the Woodthorpe Huffers and Puffers.

 

To ensure we have the correct contact details for you, please fill out this form and give it back to Margaret Deeny-Harriss

 

If you are under 16, please also ask your parent or carer to sign the form before it is returned. We will also use this information to ensure that you are kept informed about club events.

 

 

Name

                       

 

Address

                  

 

 

Postcode

 

 

Home telephone number

    

 

 

Mobile*

 

 

 

Email*

 

 

 

Date of Birth

    

 

Medical information

Please detail below any important medical information that our jog leaders should be aware of (e.g.  pilepsy, asthma, diabetes etc.)

 

 

 

 

 

 

 

Emergency contact details

 

Please insert the information below to indicate the person(s) who should be contacted in event of an incident/accident.

 

Contact name

 

 

 

Emergency contact number

 

 

 

I understand in the event of injury or illness all reasonable steps will be taken to deal with that injury/illness appropriately.

I agree that photographs taken of me by the club can be used for the purposes of Woodthorpe Huffers and Puffers publicity

 

Name:

 

 

Signature:                                  Date:

 

 

 
 
 
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