Min age for U6: Child must be 4 years old on Jan 1st this year.

Parent /Guardian information - (1 form per family required) Parent/Guardian A Parent/Guardian B Name Mobile phone Email address Address Home Phone number I am a qualified first aider and willing to help out with my Child’s team.

1. Yes & Can help Regularly 2. Yes & Can help Occasionally 3. No

I am willing to help with events and activities during the year I am or would be interested in becoming a coach or adminisstrator in the club. I consent to my child’s picture(s) being used in news items relating to Ballina GAA club

1. Yes & Can help Regularly 2. Yes & Can help Occasionally 3. No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Player Information (U6 - U16) Player Info Name - English

Player 1

Player 2

Player 3

Player 4

Male / Female

Male / Female

Male / Female

Male / Female

U__

U__

U__

U__

Name - Irish Gender Male / Female Date of birth Age group U6-U16 *see below Does your child have any medical conditions relevant to sporting activity ? Tick as Appropriate

1. Adult Membership only € 40

Full Adult Membership

2. Under 18 / Student Membership (All Children up to 18yrs & students in full-time education) 45 U18 Membership Option 1 (1 x Under 18 / Student)

€ 45

80

U18 Membership Option 2 (2 x Under 18s / Students)

€ 80

U18 Membership Option 3 (3+ x Under 18s / Students)

€ 95

3. Family Membership (U18s & students + parents / guardians) Note: Subsidised rates available to qualifying FOB members (free adult OR reduced child membership)

Family Membership Option 1 (2 x Adults & 3+ x Under 18's / students)

€ 150

Family Membership Option 2 (2 x Adults & 2 x Under 18's / students)

€ 140

Family Membership Option 3 (2 x Adults & 1 x Under 18 / student)

€ 110

Family Membership Option 4 (1 x Adults & 3+ x Under 18's / students)

€ 115

Family Membership Option 5 (1 x Adult & 2 x Under 18's / students)

€ 110 € 80

Family Membership Option 6 (1 x Adults & 1 x Under 18 / student)

I have read and discussed the club’s Code of Ethics, Conduct, and Practice with my child (code available from club website). Club Website www.ballina.tipperary.gaa.ie

Payment Received

€

Club Official signature

Date

Parent / Guardian Signature

Membership Fee Other (Hurley/Helmet) Total Note: 1. A copy of this form is available on the club website. 2. Club merchandise can be ordered on registration night. 3. Helmets will be available at a SUBSIDISED COST of €45. 4. Hurleys will be available from the club at start of season. Age Groups / year of birth

U-6/ 2007-2008 U-8/ 2005-2006

5. Please tick this box if you do not want to receive general club updates (other than matches / training specific to your child's age group).

U-10/ 2003-2004 U-12/ 2001-2002

U-14/ 1999-2000 U-16/1997-1998