Nidd Valley Junior Runners

Nidd Valley Junior Runners

Junior Membership Application Form
Personal details
An existing member and wish to renew membershipA new memberUnder the age of 8 years old - waiting list
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownCounty

Postcode
Date of Birth*

DayMonthYear
Age *
Date

MonthDayYear
Date
MaleFemale
What school do they attend?*
Year group*
YesNo
Medical Information (Please provide a hard copy of any action plan of care in the event of an emergency, Thank you)
Membership of England Athletics (If known and registered 15 years and above)
EA number
Affiliated (15 Years only for Running EventsSocial
Parkrun ID (Please provide for club events)
Parkrun is a free event on a Saturday for 5K Parkrun -under 11 must run with an adult and Sunday 2K Junior Parkrun. Register online via parkrun for ID Barcode for events and select club as NIdd Valley Road Runners
Parent/Guardian Contact details

Contactable in Emergency
Name*

First NameLast Name
Email*
example@example.com
Phone Number Mobile/Home*
Please enter a valid phone number.
Name

First NameLast Name
Email
example@example.com
Phone Number Mobile/Home
Please enter a valid phone number.
Parental Declaration

Please read carefully and tick all that apply and sign to confirm
I confirm that all the information supplied with in this form is correct to the best of my knowledge.
I give permission for the club to store and use information from this form for club purpose only
I give permission for my child to be photographed by Nidd valley club, photos will only be shared within the closed parent group of current members.I do not give permission for my child to be photographed by Nidd valley club.
I agree my child will only attend club sessions if well enough to do so and I will inform the club leader if they become unwell after any attended session/event, so appropriate action can be taken
By returning this form, my child is in good health and I agree to my child taking part in club activities. I understand that in the event of any injury or illness, all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately
I consent that in the event of any illness/accident, any necessary treatment can be administered to my Child, which may include use of anaesthetics which are necessary in the opinion of a medically qualified Practitioner. I understand that whilst the club coaching team will take every precaution to ensure Accidents do not happen, they cannot be held responsible for any loss, damage or injury suffered by my Child
I am aware of the code of conduct and agree my child should abide by this whilst in the care of the club. Repeated unacceptable behaviour will result in been sent home early, at my expense and risk thier club Place been withdrawn
I confirm my child will show kindness and support other members of the club, whilst maintaining healthy Competitiveness.
I agree to ensure my child has the right equipment and clothing when attending club sessions and events
Signature
Junior Member Declaration

Junior member to read and sign to confirm
As a member of Nidd Valley Juniors, I agree to abide by the club's rules, practices, codes and constitution and most of all have fun
YesNo
YesNo
If Yes, what do you hold?
YesNoMaybe
Payment
Full year Membership Fee - September-July - £70

Part term membership will be adjusted by each term and this will be confirmed

Please pay by bank transfer
Account name: Nidd Valley Juniors
Sort-code: 40-23-12
Account no: 12375516

When paying by bank transfer please include a
Reference based on your child and then email
This reference to the treasurer and membership
Secretary together at:
Paul Anwyl (Treasurer)
pgdanwyl@gmail.com
Emma Frankland (Membership Secretary):
niddvalleyjuniorsmembership@gmail.com

PLEASE NOTE: All existing members are required to pay membership fees when renewing their membership and before the deadline date given.

Any new members or under 8 years old will be placed on the waiting list and contacted by telephone or email when places are available to start.
Should be Empty:

Nidd Valley Junior Runners

Personal details

Parent/Guardian Contact details

Parental Declaration

Junior Member Declaration

Payment