Ddraig Wern Fencing

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Home Club (please tick):

· Ddraig Wern Gwernyfed

· Ddraig Wern Carmarthen

· Ddraig Wern Newcastle Emlyn

· Brecon Club Night

· Llandovery Juniors (U20)

Surname: _________________________________

Name:____________________________________

D.O.B:____________________________________

Address*:________________________________________________________

__________________________________________ Post Code: ____________

Emergency Contact Name & Number*:_________________________________

Email*:____________________________

For Intermediate/Advanced Fencers:

Ddraig Wern Membership No:______________

Expires on:_____________

BFA No:____________________ BFA Membership Type:_____________

Weapons Fenced: Epee/Foil/Sabre

Please tick this box if you do not want us to contact you regarding club times, term dates, and competitions: P.T.O

Are there any medical conditions or injuries that you would like to make us aware of

Do you suffer from asthma? Yes No

Are you diabetic? Yes No

Are you on any special mediation ? Yes No

Do you have any back/knee problems? Yes No

Other: (eg allergy to penicillin/plasters)___________________________

______________________________________________________________

______________________________________________________________

Please be aware that Ddraig Wern may take photos of students fencing and at competitions for advertising purposes.

Ddraig Wern would encourage you to take out Welsh Fencing Membership as this offers individual insurance and also allows you to compete in competitions. Social membership is included in beginners’ course fees.

I have read the above information and am aware that I compete at my own risk. I also agree to abide by the Ddraig Wern Club constitution:

Signed:____________________________________________

(Parent/Guardian if under 18)

Date:____/____/_____