Membership Form

Membership Application Form

Cumann Luthchleas Gael

Please complete all details in full including Parent/Guardian Contact No and
email address

Lead Applicant Details

Name

Street Address

Street Address Line 2

Postcode

Date of Birth

I hereby apply to Kilclief Ben Dearg GAC for Membership of the Club and Membership of the GAA and/or Camogie Association and/or Ladies Gaelic Football Association (U12’s only) to play the following sports: (Please check appropriate)

Adult Member Code Playing:

Gym

Football

Hurling

Camogie

I/We subscribe to and undertake to further the aims and objectives of Kilclief
Ben Dearg GAC and of the GAA and Camogie Association and to abide by their
Rules, including the Codes of Conduct and I attach the appropriate Annual
Membership fee as determined by Kilclief Ben Dearg GAC.

Child 1 Medical Information:

Child 1: Please state clearly any medical, Physical or learning conditions which the above member currently has (please include any Allergies like Nuts, Penicillin etc):

Child 1: I consent to the processing of personal medical data as outline above for the purpose of administering medical assistances to the above if required

Yes

Child 1: And may require the following medication/ treatment when away from home at training or matches: (Please list medications/treatments)

Child 1: In the event of illness/ injury, I give permission for medical treatment to be administered by a nominated first aider, or by a suitably qualified medical practitioners

Yes

Child 1: If I the parents/ Guardian cannot be contracted and my child required emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency treatment or medication

Yes

Child 2 Medical Information:

Child 2: Please state clearly any medical, Physical or learning conditions which the above member currently has (please include any Allergies like Nuts, Penicillin etc):

Child 2: I consent to the processing of personal medical data as outline above for the purpose of administering medical assistances to the above if required

Yes

Child 2: And may require the following medication/ treatment when away from home at training or matches: (Please list medications/treatments)

Child 2: In the event of illness/ injury, I give permission for medical treatment to be administered by a nominated first aider, or by a suitably qualified medical practitioners

Yes

Child 2: If I the parents/ Guardian cannot be contracted and my child required emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency treatment or medication

Yes

Child 3 Medical Information:

Child 3: Please state clearly any medical, Physical or learning conditions which the above member currently has (please include any Allergies like Nuts, Penicillin etc):

Child 3: I consent to the processing of personal medical data as outline above for the purpose of administering medical assistances to the above if required

Yes

Child 3: And may require the following medication/ treatment when away from home at training or matches: (Please list medications/treatments)

Child 3: In the event of illness/ injury, I give permission for medical treatment to be administered by a nominated first aider, or by a suitably qualified medical practitioners

Yes

Child 3: If I the parents/ Guardian cannot be contracted and my child required emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency treatment or medication

Yes

Parents(s)/Guardians(s) Consent (if applicable) on behalf of the above named:

Kilclief Ben Dearg GAC feel it is important to recognise the achievements & successes of our youth and of the club as a whole. One of the ways to do this is to publish photographs and details of achievements in our local. As a club we would like to use pictures of our youth members in the local press and at times, on the club Facebook page.

We take the issue of child safety very seriously and this includes the images of the children in our care. Our duty to our young members is paramount and this form of publicity must be carefully monitored to ensure that it is consistent with our Child Protection Policy and the Data Protection Legislation.

For this reason we have put the following guidelines into place:

We ask parental consent for the club to take and use photographs of their children and for permission to use the press and media to promote the youth programme while representing Kilclief Ben Dearg GAC.
Photographs and interviews will at all times take place in the presence of a coach.
We will only use team/action photographs on our Club Facebook page and in the local press.
Action and individual photographs will only be used, with individual parental consent, prior to the inclusion on the club Facebook page or in the local press.
Photographs taken by parents/guardians at matches, can only be used with the permission of the other clubs and agreed with the relevant coach from Kilclief Ben Dearg GAC.

I have read the conditions of use and consent to my childs/childrens photograph being used. If there is any change to my decision, I will inform the club.

Additional Consent:

Consent to the above Application and to undertakings given by the Applicant

Yes

Will do my best to ensure that my child and I will adhere to the various Codes of Conduct

Yes

We/I understand that my child’s Personal Data will also be used for administrative purposes to maintain membership including registrations, team-sheets, referee reports, disciplinary matters, Injury Reports, transfers, sanctions, permits and for statistical purposes

Yes

I understand that the personal data on this form will be retained by the Club & the Association for such period as the Applicant’s membership subsists and for a reasonable time thereafter

Yes

I understand that if I do not provide the Applicants Personal Data Membership cannot be registered with the Club and the Association

Yes

Sign Here:

Date

Family Discount

A 20% family discount will apply when at least one parent/ guardian also becomes a full member with their child(ren)