Membership Registration Form

Member details

First Name *

Last Name *

Address *

Email Address *

Phone Number *

Membership details

Membership Options *

Include additional names for Membership

My child has permission to gain Teleyouth membership. I agree to allow my child to access internet games, suitable to their age group. I understand that if my child is under 10 years old they must be accompanied by a parent or guardian when using the CRC facilities.

I understand that any inappropriate behaviour or breach of membership conditions/code of conduct will automatically result in immediate suspension of membership. Parents will be notified if an incident occurs.

Parent/Gardian Signature

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Your CRC Membership automatically gives you a membership with the Vic Conte Community garden.

Would you like to make a donation to the garden?

NoYes

Amount $

Please let us know any comments or questions that you might have

I agree to the Membership conditions & Code of Conduct of this membership application. *

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Applicant signature *

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