Registration Form

Personal Details = required

Full Name

Home Address

Home Phone

Mobile Phone

Email Address

Alternate Email

Date of Birth

Gender

Male Female

Membership Start

When would you like your membership to start?

As Soon As Possible Specific Date Start of Next School Year

Preferred Start Date
(if applicable)

Membership Category

Please select your preferred membership category

	Category	Cost
	Junior Friday nights, once a month, 6:30pm - 8pm. Usually on the first Monday of the month, but check the events calendar! Entry is £3.50 and includes a bag of tuck. Only available to people between the ages of 8 and 10 inclusive.	£0.00
	Senior Monday nights, weekly, 7pm - 9pm. The club is one most Mondays, except for school holidays, but please check the events calendar! Entry is £2.50 and tuck is available to buy on the night. Only available to people between the ages of 11 and 17 inclusive.	£0.00
	Volunteer Only available to people aged 18 or over.	£0.00

Data Protection

I understand that any personal data I provide on this site will be processed in accordance with the Terms & Conditions and Privacy Policy. I have read and agree to the Terms & Conditions (https://pyc.myclubhouse.co.uk/Home/TermsAndConditions) and the Privacy Policy (https://pyc.myclubhouse.co.uk/PrivacyPolicy;).

Signature

Date

Please return completed forms to: Plaistow Youth Club, Rear of Winterton Hall, Loxwood Road, Plaistow, West Sussex, RH14 0PX

Use this form to send an email to another member. You may only send to one member at a time. Your registered email address will be passed on to this member but you may also include alternative contact details.

Note: Emails sent via the website are not entirely private. A copy of every email is held on the database and this can be accessed by certain club administrators using the Sent Emails page.

From

Alternative contact email

Another email address which the recipient can use to contact you.

Alternative contact details

Other contact details which the recipient can use to contact you e.g. phone number.

Subject

Message

Copy this message to my email address

Title

Description

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