Section A: MEMBER DETAILS. Member Full Name*

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Address, City, Postcode*

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Date of Birth (DD/MM/YYYY)*

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Name of School*

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Are you a member of any other sports club? (If yes, please state which club and which sport)*

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Oxford Elite Basketball Academy Membership number*

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Basketball England Membership if have one*

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SECTION B: PARENT/CARER DETAILS / Full Name*

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Address, City, Postcode*

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Mobile number*

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Email Address*

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SECTION C: PARENT/CARER HELP. Please tick areas that you would be interested in helping with.*

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Helping at athletic meetings

Refreshment area

Fund raising

Assisting Training

Team management

Promotion and marketing

Other (please specify)

SECTION D: MEDICAL INFORMATION.Please detail below any important medical information that our staff should be aware of (e.g. epilepsy, asthma, etc.)Do not leave blank-if there is no info write NONE*

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SECTION E: EMERGENCY CONTACT DETAILS. Please insert the information below to indicate the persons who should be contacted in event of an incident/accident. Emergency contact one FULL NAME*

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Emergency contact one Phone number: *

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Emergency contact two FULL NAME*

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Emergency contact two Phone number: *

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SECTION F: PARENTAL/CARER AGREEMENT *

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By returning this completed form, I agree:To the named athlete taking part in the activities of the club.

That I have read and agree to abide by the club code of conduct whenever I am present at club activities or competition

I hereby agree that this data will be stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*

* Indicates required fields

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Oxford Elite Basketball Academy

MEMBERSHIP FORM

Welcome to Oxford Elite Basketball Academy.

To ensure we have the correct contact details for you, please fill out this form

We look forward to welcoming you and your family to the club in the near future. To find out all the latest club information, please visit our website www.oxfordeliteacademy.co.uk