Wadi Degla Application Form

sports leisure arena in kenya

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MEMBERSHIP APPLICATION FORM WADI DEGLA INVESTMENTS LIMITED

PRINCIPLE MEMBER DATA Full Names: Date of Birth:

D

M

Y

D

M

Y

ID/Passport No: PIN No: Marital Status: No. of Children: Postal Address: Code: City/Town: Home Phone: Mobile No: Office No: Email Address: Nationality: Employer: Position: Sports Practiced: Other club memberships: Have you ever been expelled from any private membership club?

YES

NO

If so please provide details:

Other Interests:

SPOUSE DATA Full Names: Date of Birth: ID/Passport No: PIN No: Marital Status: No. of Children: Postal Address: Code: City/Town: Home Phone: Mobile No: Office No: Email Address: Nationality: Employer: Position: Sports Practiced: Other club memberships: Other Interests: 3

INTRODUCTION Introduced by

Membership No.

Name

Signature

CHILDREN 1.)

Full Names: Date of Birth:

D

M

Y

D

M

Y

D

M

Y

Sports Practiced: Other Interests:

2.)

Full Names: Date of Birth:

Sports Practiced: Other Interests:

3.)

Full Names: Date of Birth:

Sports Practiced: Other Interests:

NEXT OF KIN Full Names: Mobile No: Relationship:

BENEFICIARY Full Names: Mobile No: Relationship:

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ADDITIONAL CHILDREN 4.)

Full Names: Date of Birth:

D

M

Y

D

M

Y

D

M

Y

Sports Practiced: Other Interests:

5.)

Full Names: Date of Birth:

Sports Practiced: Other Interests:

6.)

Full Names: Date of Birth:

Sports Practiced: Other Interests:

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MEDICAL INFORMATION PRINCIPAL MEMBER: Full Names: Pre-existing conditions: Allergies: Preferred Doctor/Family Doctor: Medical Insurance (if any):

SPOUSE: Full Names: Pre-existing conditions: Allergies: Preferred Doctor/Family Doctor: Medical Insurance (if any):

CHILDREN: 1.) Full Names: Pre-existing conditions: Allergies: Preferred Doctor/Family Doctor: Medical Insurance (if any):

2.) Full Names: Pre-existing conditions: Allergies: Preferred Doctor/Family Doctor: Medical Insurance (if any):

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3.) Full Names: Pre-existing conditions: Allergies: Preferred Doctor/Family Doctor: Medical Insurance (if any): 4.) Full Names: Pre-existing conditions: Allergies: Preferred Doctor/Family Doctor: Medical Insurance (if any): 5.) Full Names: Pre-existing conditions: Allergies: Preferred Doctor/Family Doctor: Medical Insurance (if any):

NANNY APPLICATION FORM (Optional) Full Names: Date of Birth: ID/Passport No: Postal Address: Code: City/Town: Mobile No: Allergies:

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D

M

Y

AFFIX PHOTOS HERE

Name: Name: Name: Name:

Name: Name: Name: Name:

Name: Name: Name: Name:

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CHECKLIST

ID/PASSPORT COPY PIN CERTIFICATE COPY (principle member and spouse)

PASSPORT SIZE PHOTOS (2 copies each)

COPIES OF BIRTH CERTIFICATES (for the children) MEDICAL INSURANCE CARDS (copies-if any)

I/We hereby apply for membership of Wadi Degla Club. I/We confirm that all information provided on the form is accurate and that I/We are Citizen(s) of good standing. I/We know of no reason why the club management should not consider the application.

I/We accept that the application is subject to the scrutiny by the Club and their decision is final. I/We also accept that should the application be successful, I/We agree to abide by the constitution and by-laws of Wadi Degla Club. I/We understand that if the application is successful and the membership fee paid (whether in part or in full) it is not refundable should I/We choose not to go ahead with the application process.

Principle Members Signature: ………………………………………………….……………………………………. Date: ………………………………………………

Spouse’s Signature: …………………………………………………………………..……………………………………. Date: ……………………………………………….

FOR OFFICIAL USE ONLY Payment Details: Membership fees (Kshs) Paid by Cash/Cheque/EFT

Annual Maintenance Fee for year :

Membership Fee paid by:

Point System Evaluation No: Approved:

Yes

No

The Form has been checked and all the elements verified: …………………………………………………………………………………… ………………………………………………………………………………………………

Signed by Club Manager Date

Membership Registration Number Assigned: …………………………………………..………………………………………………………………………

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Please insert copies of relevant documents in the pocket

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Fun Fitness Health Lifestyle Culture Family

Fill The Application Form & Send It To Wadi Degla Kenya

Tel 1 : +254 701 950 549 Tel 2 : +254 788 888 818 1st Floor Piedmont Plaza, Ngong Road P.O.Box 41973-00100 - Nairobi, Kenya www.wadidegla.co.ke