Membership If the child is under 18, this form needs to be completed by the primary parent/caregiver of the child Step 1 of 5 20% Membership Option*Membership Prices from 1st September – 31st August Parafed Waikato is a non-profit organisation. The society’s goal is to improve life quality for Waikato physically disabled and visually impaired through active participation in sport and recreation. Membership Cost: Full Membership - $35.00. Full membership is required by all those seniors (19 years and over). This includes social athletes who only participate in sport at local training sessions as well as athletes who wish to compete at events/games/nationals and/or wish to apply for club supported funding. This also includes coaches and officials who wish to apply for financial assistance from us. Junior Membership - $20.00. Junior membership is for individuals aged 18 years and under or still at school. These members have “full membership” rights. This also includes junior coaches and officials. Social Membership - $20.00. Social membership includes those who are supporters, volunteers, family members as well as athletes who only participate in our fitness revolution programme. Full Senior MemberJunior MemberSocial Member Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Last Date of Birth*GenderMaleFemaleEthnicity (Optional)Email Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*Enter your contact phone number here.Mobile PhoneEnter your contact phone number here.Emergency Contact PersonEmergency Contact Phone Communication Channel*Please select as many as necessary Email Phone Newsletter None Impairment/Physical disability:Wheelchair User Yes No N/A Classification Yes No N/A Classification details:NZ Paralympian Yes No N/A Current schoolSportsSelect (+) to choose more than one sport and sport status.Sport NameSport Status Adaptive rowingBlind CricketBocciaCyclingFitness RevGoalballHalberg GamesLawn BowlsPara ClimbingPara TriathlonPowerchair FootballRock ClimbingShootingSwimmingWheelchair BasketballWheelchair RugbyWheelchair TennisN/APlayerCoachAssistant CoachReferee/OfficialManagerSupporter/VolunteerCommittee MemberInterested inN/A SportsAdaptive rowingBlind CricketBocciaCyclingFitness RevGoalballHalberg GamesLawn BowlsPara ClimbingPara TriathlonPowerchair FootballRock ClimbingShootingSwimmingWheelchair BasketballWheelchair RugbyWheelchair TennisN/ASports StatusPlease select your involvement with each sport: PlayerCoachAssistant CoachReferee/OfficialManagerSupporter/VolunteerCommittee Memberinterested inN/AList any sports or programmes you want to be involved in You're almost done!Once you click 'submit' we will take you to the page with payment information.I agree or give permission that any images that have been captured of me or my child participating in a Parafed Waikato activity or event can be used by Parafed Waikato. I agree to terms and conditions Disclaimer*Over 18 Disclaimer – I state that I am physically and medically sound to proceed with the activities of Parafed Waikato and that they shall not be liable in any way for personal accident or loss of property. All people and equipment within the organisation must be treated with respect and the organisation rules must be adhered to at all times. Under 18 Disclaimer – I, the primary parent/caregiver of this child, state that he/she is physically and medically sound to proceed with the activities of Parafed Waikato and that they shall not be liable in any way for personal accident or loss of property. All people and equipment within the organisation must be treated with respect and the organisation rules must be adhered to at all times. I agree to terms and conditions Total $ 0.00
