TALLAGHT YOUTH BAND

MARCHING VIKINGS

MEMBERSHIP APPLICATION FORM

NAME: ___________________________________

ADDRESS: ___________________________________

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HOME PHONE NUMBER: ____________ MOBILE: _______________

DATE OF BIRTH: ____________ AGE: ______________

Please tick one of the following boxes:

INSTRUMENT FLAGS MAJORETTES

NEXT OF KIN: __________________________________

NEXT OF KIN SIGNATURE: __________________________________

DATE: __________________________________

NOTE:

PLEASE DISCLOSE ANY INFORMATION OF MEDICAL CONDITIONS THAT MAY BE NECESSARY TO THE BAND COMMITTEE.

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THE NEXT OF KIN’S SIGNATURE ACKNOWLEDGES, THEIRS AND THEIR CHILDS ACCEPTANCE OF THE CODE OF CONDUCT AND CARE OF BAND EQUIPMENT, WHICH WILL BE EXPLAINED WHEN THE APPLICATION HAS BEEN ACCEPTED.