Membership Application Form – Junior Blades Ice Skating Club

Member demographics(Race) are required by the Department of Sport & Recreation for statistical purposes.

Please do not use all caps to complete the form and please use names that you would like to appear on your child’s certificates and badges.

Please note that photos may be taken during club lessons, events and competitions for use on Junior Blades’ social media.

* Required field
Parent/Guardian Details or Skater's details if over 18 :
Name (*)		Surname (*)
Date of Birth (*)		ID Number (*)
Your Race (*)		Gender (*)
Email (*)		Alternative Email
Telephone Home		Telephone Work
Telephone Cell (*)
Postal Address (*)
Suburb (*)
Postal Code (*)

Child 1 / Skater Details:
Child 1 / Skater Name (*)		Child 1 / Skater Surname (*)
Child 1 / Skater Date of Birth (*)		Child 1 / Skater ID Number (*)
Child 1 / Skater Gender (*)		Child 1 Skater Race (*)
Child 1 / Skater Medical Conditions

Child 2 Details:
Child 2 Name		Child 2 Surname
Child 2 Date of Birth		Child 2 ID Number
Child 2 Gender		Child 2 Race
Child 2 Medical Conditions

Child 3 Details:
Child 3 Name		Child 3 Surname
Child 3 Date of Birth		Child 3 ID Number
Child 3 Gender		Child 3 Race
Child 3 Medical Conditions

Child 4 Details:
Child 4 Name		Child 4 Surname
Child 4 Date of Birth		Child 4 ID Number
Child 4 Gender		Child 4 Race
Child 4 Medical Conditions

Please leave this field empty.