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  • Mount Hawke Youth & Community GroupMember Registration
     
  • PERSONAL INFORMATION
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  • EMERGENCY CONTACT INFORMATION
  • MEDICAL HISTORY
  • HAVE YOU A HISTORY OR RECEIVE MEDICATION FOR ANY OF THE FOLLOWING:
  • TICK AS APPROPPRIATE
  • DECLARATION
  • I confirm that I have received and read a copy of the Member Information and Terms and Conditions and fully understand and agree to them.
  •  / /
  • FOR MEMBERS UNDER THE AGE OF 16
  • I am the Parent / Guardian of the member and I have received and read a copy of the Member Information and Terms and Conditions and fully understand and agree to them on the member"s behalf.
  •  / /
  • Please enter address details if different from above
  • Mount Hawke Youth & Community Group - Registered Charity No. 1182950 - www.mounthawke.com
     
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