SUSSEX COUNTY LTC JUNIOR APPLICATION FORM 2018 – 2019 Age Under 18 Step 1 of 4 25% Name* First Last Address* Address Line 1 Address Line 2 City County Post Code Phone Number*Phone Number (optional)Email Address* British Tennis Membership NumberPlease note that this information may be stored on a computer database and a website run on a server outside the EU and UK. Membership Category*Junior aged 11 to 18 (born 2000 or later)Junior aged 10 and under (born 2008 or later)Total £ 0.00 Payment Method*ChequeBank TransferCardCheques should be made payable to Sussex County LTC.For bank transfers please contact the club.For card payments please pay online at the end of the form. British Tennis Membership*YesNoPermission for the club to sign you up to free British Tennis Membership Lite.Special RequirementsPlease describe any special care needs, dietary requirements, allergies or medical conditions.If you do not wish your photograph to be taken and used by the club on the website, please advise the club at the time the photograph is taken. Card Total £ 0.00 Credit/Debit Card* MasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Junior Member's Signature*Date* Parent / Guardian declaration (essential if applicant is under 16 years of age)* I agree to my son/daughter taking part in the general activities of the club. He/she has agreed to follow the junior rules of the club and I agree to accept the code of conduct for parents. To my knowledge, he/she has no special care needs, dietary requirements allergies or medical conditions that could affect his/her safety at the club; other than those declared on this form. I understand that in the event of any injury, illness or other medical need all reasonable steps will be taken to contact me and deal with the situation appropriately. I understand that I must inform the club of any changes to the information provided on this form. Parent/Guardian Signature*Date* * I consent to scltc.co.uk collecting and storing my data from this form. Card data is not stored. EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.