APPLICATION FOR MEMBERSHIP FOR 2011

I wish to apply for membership of Wanganui Boys & Girls Gym Club (“Club”) located at Springvale Park, GF Moore Drive, Wanganui and in so doing also apply for membership of GymSports NZ Incorporated located at Level 2, 6 Arawa Street, Grafton, Auckland.

This form has been prepared to ensure compliance with the Privacy Act 1993 and the Incorporated Societies Act 1908. Please complete all spaces on the form for each person applying for membership. Failure to complete all spaces may result in refusal to accept membership. For more information please refer to the GymSports NZ Membership Data Regulation. If the gymnast is under 18 years, the parent/guardian/caregiver should complete this form for the gymnast as detailed below.

CLASS DETAILS

Class

Day

Time

PERIOD OF MEMBERSHIP

Indicating full year/term refers to the membership details on this form and is required for the Privacy Act. Payment of fees is separate and based on the club’s policy. A new form will be required on completion of the indicated period.

Options

Full year 1 Jan to 31 Dec 2011
Term 1 in 2011
Term 2 in 2011
Term 3 in 2011
Term 4 in 2011

GYMNAST DETAILS

Title

Given Name

Surname

Date of Birth

Gender

male
female

Ethnicity

Address

Suburb

Town / City

Post code

Phone (home)

Please list any medical conditions that may impact on the gymnast participating in Gymsports (eg epilepsy, asthma, allergies etc).

Description

In the unlikely event of an injury or illness occurring while the gymnast is participating in Gymsports, the Club or GymSports NZ (as applicable) will make every effort to contact the emergency contact listed above as soon as possible. By signing this form you authorise the Club to administer such first aid as it considers necessary.

INFORMATION FROM SPONSORS

I agree that GymSports NZ or my Club may contact me from time to time to provide me with information about the products and services of my Club or GymSports NZ sponsors or funders.

Agree
Disagree

DECLARATION

For members over 18 years:

I have read and consent to the Membership Declaration

I am over 18 years

Name of Applicant

Date

For members under 18 years:

I have read and consent to the Membership Declaration

I am the parent/guardian/caregiver of the gymnast who is under 18 years of age. I have read and understood this form and the Membership Declaration. I consent to the gymnast’s application for membership on the basis set out in this form and the Membership Declaration. I also consent, or am authorised to consent, to the emergency contact details specified in this form being held by the Club and GymSports NZ for the purposes of contacting the person(s) named in an emergency. If I am not a member myself, I also consent to my name and contact details as set out below, being collected, held, and used as the gymnast’s parent, guardian or caregiver in accordance with the purposes set out in paragraph 7 of the Membership Declaration as if I were a member of GymSports NZ.

Name

Phone (home)

Phone (work)

Mobile

Email

Date

PAYMENT

Click here for fees

Please select one

DC Westpac 03-0791-0562930-00 (reference of Child’s Name)
Cheque (please include cheque number and reference of Childs Name)
Eftpos on arrival of first class
Cash on arrival of first class