Ballinkillen Juvenile Hurling Club Membership Application Form To be completed and returned on or before Registration night to a club officer or mentor with your Membership Fee: U6: €5 /

Individual U8 – U16: €20 / (Juv. Hurling Club) Family: €35

Child’s Name(1)*: ___________________________________________ Date of Birth*: ______________________ Child’s Name(2): ____________________________________________ Date of Birth: _______________________ Child's Name(3): ____________________________________________ Date of Birth: _______________________ Child's Name(4): ____________________________________________ Date of Birth: _______________________ Home Address*: _______________________________________________________________________________

Home Tel. number:__________________________ Emergency Contact Number*:__________________________ Child’s School(1)*: ______________________________________________________________________________ Child’s School(2): ______________________________________________________________________________ Child’s School(3): ______________________________________________________________________________ Child’s School(4): ______________________________________________________________________________ Any relevant medical condition(s) or relevant medication information about your child/children that team mentors need to be aware of:

_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

Parent/Guardian(1)*: ______________________________________________________(PRINT) Parent/Guardian(2): _______________________________________________________(PRINT) Information on team training, games or Club news will be sent to you on a regular basis via group texts. It is Ballinkillen Juvenile Hurling Club's wish that this information be sent to the parents or guardians of our underage players rather than directly to the underage players. What telephone contact number may we use for this purpose?

Information Contact Number (mobile phone number)*: ________________________________________________ Information Contact e-mail address: ________________________________________________________________ I understand and accept the GAA Code of Behaviour, on my own behalf and on behalf of my child*.

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Signature of Parent/Guardian* __________________________________________ Date*: __________________ During the season our teams may be photographed or filmed for coaching purposes, or as part of match coverage in newspapers or for use on the Ballinkillen Hurling Club web site or for publicising our Club. Such photographs will adhere to the GAA Guidelines for use of photography and filming and should you object to your child being photographed or filmed please inform a club officer or your team manager as part of this registration procedure. (Fields marked with * are the minimum required).

Club Website: www.ballinkillen.carlow.gaa.ie

Twitter: @BallinkillenHC