Membership Form

By Ticking this box you consent, that a copy of this document is sent to you*

Yes

Name of Member*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Date of Birth*

Place of Birth*

Mobile Contact Number*

Please enter a valid phone number.

Email*

example@example.com

Are you a member of any other athletics club or sports, if yes, please indicate which club or sports*

What area of athletics are you interested in*

MEDICAL INFORMATION Please detail below any important medical information that our coaches/co-ordinators should be aware of e.g. epilepsy, asthma, diabetes, allergies etc.*

Emergency Contact Name*

Mobile Contact Number*

Please enter a valid phone number.

CONSENT It may be essential at some time for authorised persons acting on behalf of the club to have the necessary authority to obtain urgent treatment which may be required whilst representing the club in training or competition.

Signed (this will be treated as an electronic signature) C*

PARENT/CARER DETAILS

If the athlete is under 17 please ask Parent/Carer to complete this next section

Parent/Care Name

ATHLETE AGREEMENT by completing this form you are:

Willing to abide by the club code of conduct for athletes (available on the website)

Agree always to behave in a manner befitting a Middlesbrough AC (Mandale) when attending events.

Agree to compete for the club in team competition, if selected.

Confirm that I am eligible to compete under UK Athletics rules.

I am, as far as I am aware, fit to take part in strenuous physical activity.

I agree to the disclosure of my name and date of birth in a list of members to English Athletics

Signed (will be treated as an electronic signature) AA

PHOTOGRAPHY & VIDEO CONSENT (those aged 18 and under)
Middlesbrough AC recognises the need to ensure the welfare and safety of all young people in athletics.

In accordance with the UK Athletics child protection policy and procedures, we will not permit photographs, video or other images of children/young people to be taken without the consent of parents/carers and children/young people.

The Club will take all possible steps to ensure these images are used solely for the purposes they are intended. If you become aware that these images are being used inappropriately, you should inform the Club welfare officer immediately.

The parent/carer consent to Middlesbrough AC (Mandale) or a photographer appointed by the club photographing or videoing my child’s involvement in athletics for the purposes of publicising and promoting the club or sport, or as a teaching aid.

Club Privacy Statement:
The Club takes the protection of the data that we hold about you as a member seriously and will do everything possible to ensure that data is collected, stored, processed, maintained, cleansed and retained in accordance with current and future UK data protection legislation.

Please read the full privacy notice carefully (found under Governance) to see how we will treat the personal information that you provide to us. We will take reasonable care to keep your information secure and to prevent any unauthorised access.

Data sharing with England Athletics:
When you become a member of or renew your membership with Middlesbrough AC (Mandale) if you are going to compete, you will be registered with and become a member of England Athletics. If you have any queries about the privacy of your personal date when shared with EA, please contact them dataprotection@englandathletics.org or discuss with the Membership Secretary.

Signed (this will be treated as an electronic signature) PVC*

Membership Types

Membership Form

Credit Card