LAMDAA Fishing Club Junior/Youth

Membership Form
Please use block capitals.
Personal Details:
Name: ............................................................................................ Date of Birth: .. Age: ...........
Address: .......................................................................................................................................................................
Postcode: ..................... Tel: ......................................... E-mail: ................................................................................
Medical/ Injury Details:
Detail any medical conditions/ allergies that we should be aware of and any medication
required? .......................................................................................................................................................................
Emergency Contact:
Name: ........................................................................ Tel: ...........................................................................................
Disability
The Disability Discrimination Act 1995 defines a disabled person as anyone with a physical or mental impairment, which has a substantial and
long-term adverse effect on his or her ability to carry out normal day-to-day activities.

Do you consider yourself to have a disability? Yes No If yes, what is the nature of your disability?
Please specify:
Membership Fees:
Junior/Youth membership

Fee:
10.00

Please tick:

Total
All members over 12 will require a Game rod licence to fish Loughmacrory . LAMDAA Associate/Parental members will have no voting rights at
club meetings or AGM. Membership will run for 12 months from 1st of March each year. Full details available on our website .. No guests
allowed at LAMDAA
By signing this form you are agreeing to abide by the club rules, constitution, all policies and procedures and code of ethics as well as all other
laws regarding Angling as set out by local Councils, Government and Governing Bodies.

Signed: Date:

Swimmer
Non Swimmer

Consent for Junior/Youth Members:

Consent must be provided by person with parental responsibility. (Article 6)
Signed: ..................... (Parent/Guardian/Carer) Date: ..............

The Childrens (NI) Order Article 6

(1) Natural Mother always has parental responsibility. (2a) Natural father gains parental responsibility. (2b) If married to mother at time of birth or
subsequently marries her. (2c) Through an Agreement witnessed by solicitor or a Parental Responsibility Order. (2d) Post 15 April 2002 if they
jointly register the babys birth.

Please return forms to the Club Treasurer: Cheques made payable to LAMDAA Fishing Club
Cahir Mc Govern
16 Pinefield Walk
Omagh

BT797YP

All club sessions involving Junior/Youth members are run under the guidance of club Child Protection
Officers.
Name of Child: Date of Birth:............
Address:............................
Postcode:.
Does the child suffer from any medical conditions/allergies that the club should be aware of (including any current
medication) ....................................................................................................................................................................
.................................
Please provide details of medication that must be administered: ............................
Emergency contact details:
Name: Telephone No:...............................
Relationship to child: . Email:.
CONSENT (please read carefully)
Consent must be provided by person with parental responsibility. (Article 6)
a) I agree to the above named child taking part in the activities of the club.
b) I confirm to the best of my knowledge that the above named child does not suffer from any medical condition
other than those listed above.
c) I consent to the above named child travelling by any form of public transport, minibus or motor vehicle driven
by a hired driver, club volunteer or any other parent attending, to any event in which the club is participating.
d) I understand that the Club or Organisers accept no responsibility for loss, damage or injury caused by or during
attendance on any of the clubs organised activities except where such loss, damage or injury can be shown to
result directly from the negligence of the Club or the Organisers.
e) I hereby consent to lamdaa Fishing Club photographing or videoing my child/children. Please tick.
f) I do not consent to lamdaa Fishing Club photographing or videoing my child/children.
Please tick.
LAMDAA Fishing Club recognises the need to ensure the welfare and safety of all young people. In accordance with
our child protection policy we will not permit photographs, video or other images of young people to be taken without
consent of the parents/guardian/carer and children.
LAMDAA Fishing Club will take steps to ensure these images are used solely for the purpose they are intended.
This may include press releases, press nights, advertising and use on our club website, Facebook and Twitter
pages. If you become aware that these images are being used inappropriately, you should inform us immediately.
Signed: ..................... (Parent/Guardian/Carer) Date:
..............
The Childrens (NI) Order Article 6
(1) Natural Mother always has parental responsibility. (2a) Natural father gains parental responsibility. (2b) If married
to mother at time of birth or subsequently marries her. (2c) Through an Agreement witnessed by solicitor or a
Parental Responsibility Order. (2d) Post 15 April 2002 if they jointly register the babys birth.