2015 Registration Form - St. Michael`s GAC Lissan

St Michael’s GAC Lissan
Naomh Mhichil Lios Aine
Youth and Adult Membership Form 2015
Name
DOB
Please outline any underlying medical
condition or medication (under 16 only)
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I hereby apply to the above club for membership of Cumann Lutchleas Gael (Gaelic Athletic
Association) and Cumann Peil Gael na mBan (Ladies Gaelic Football Association). I subscribe and
undertake to further the aims and objectives of St Michael’s GAC and to abide by its rules. I attach the
appropriate membership fee
Parent(s) / Guardian(s) consent on behalf of the above applicant(s).
I / We consent to the above application and to undertakings made by the applicant
Sinithe / Signed …………………………………………….
Print Name
Address
…………………………………………….
Parent / Guardian
Date …………………..................
……………………………………………………
……………………………………………………
Tel Number
Post Code
BT ……………...
………………………………….. Mobile Number ……………………………….
Policy on Digital Images St Michael’s GAC Lissan will permit the use of photographs and any other
imaging only in appropriate circumstances such as action shots during the course of play or in team photographs.
Children on these occasions will be appropriately attired. Children will not be identified by name
Parent(s)/ Guardians(s) Consent for Members Under 16 years of age
Please tick as appropriate
Do you give permission for emergency medical treatment
Do you give consent to the above policy on photography/ videoing
Do you give consent to comply and support the codes of conduct
Do you give permission for the Club to send Text regarding Club Events
Are you willing to assist in any manner
Under 18 yrs £10
Adult (18 to 65 yrs) £20
Membership Fees
Family 2 Parents / Guardians plus all children aged under 16 £40
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Over 65 yrs £10
For Official Use Only
Approved by Club Executive on Date : ........................................................................
Club Runai / Sinith : .......................................................................