Member Form

Title :

First Name :

Last Name :

Address :

Postcode :

County :

Phone :

Mobile :

Email :

Secondary Email :

Next of Kin :

Next of Kin Contact Number :

Other Club Memberships

Details of other Memebership (if Applicable)

How did you hear of us ?

Type of Membership

Club Gear Size

Medical History Information
Please provide details of any known allergies and medical conditions the member/s have. Please provide details of any medication that may be relevant to Anti-Doping regulations. If you are unsure please speak with any of our coaches who will advise you further.

Are there any other special needs, requirements or directions that would be helpful for leaders/coaches.

In the event of illness or accident, having parental responsibility, I give permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitably qualified medical practitioners. If I cannot be contacted and my child needs emergency hospital treatment, I authorize a qualified medical practitioner to provide emergency treatment or medication.

Photographs and film

I understand that photographs or film may be taken during or at sport related events and may be used in the reporting or promotion of the sport.

Yes No

Athlete Promise

- I agree to the rules of the club and to train to the best of my ability and compete for the club.

- I agree to accept coaching from the club and to behave in an appropriate way at all times.

- I will have fun, make friends and learn about athletics from my coaches and mentors.

- I agree to help out and take part in fundraising activities for the club.

- I confirm I have read the Health, Safety and Welfare Policy document

Yes No

Declaration: I confirm that all details given on this from are accurate and I agree that I cannot claim back the registration fee I paid under any circumstance.

I Agree Don't Agree

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