Membership Personal InformationPlease enter your personal details so your captain have all the details they need in case of emergency Name * First Name Last Name Date MM DD YYYY Email * Phone * (###) ### #### Address * Emergency Contact Information (required) Primary Contact Name * First Name Last Name Relationship to Member Phone Number (###) ### #### Alternative Phone Number (###) ### #### Secondary Contact Name (###) ### #### Relationship to Member Phone Number (###) ### #### Alternative Phone Number (###) ### #### Medical Information Medical Conditions (e.g., asthma, diabetes): Medications Currently Taking: Allergies (e.g., food, medication): Doctor or GP Name / Surgery Consent and Acknowledgment: I, the undersigned, authorize the sports club to contact the above emergency contacts and medical professionals in the event of an emergency. I also consent to the release of my medical information to emergency personnel as necessary. Name - Typed will be considered as signature Parent/Guardian Name (if under 18): Date Completed MM DD YYYY Thank you!
