Blackburn Harriers and Athletics Club

Application for Membership
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownCounty

Postcode
Email
example@example.com
Phone Number*
MaleFemale
Date of Birth*

DayMonthYear
Date
School Year if applicable
I am applying for the membership of the SPORTSHALL Group (Held on Mondays) which is for beginners and aged 8 years - 11 yearsThrowsHurdlesJumpsSprintsMiddle DistanceCross CountryRoad RunningFell RunningCoachingI am interesting in volunteering to help the club and/or becoming an Official for the Track and Field season
Primary Emergency Contacts Details
Emergency Contact 1

First NameLast Name
Phone Number

Area CodePhone Number
Emergency Contact 2

First NameLast Name
Phone Number

Area CodePhone Number
A medical form needs to be completed for all Under 18 athletes. For Seniors, if you wish to inform us of any health issues - please add below
Under 18sOver 18s
Senior Health Issues
Medical/Welfare Information

For Under 18's Only
Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Medical Information

This information will ne held in the strictest confidence for use by Club Officials in their duty of care. We understand it is unreasonable for members to divulge their full medical history and have the right
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Please list any current Medical Conditions that may affect your welfare during Training sessions of competition events*
Allergies - Do you suffer from any significant allergies? Please list previous symptoms and the treatment required in the past*
Drs Details (including phone number)*
I consent for Blackburn Harriers to store my details within the Blackburn Harriers' database.
As part of England Athletics each member of Blackburn Harriers needs to read and agree to the code of conduct for their particular age group.

Codes of Conduct Click to read the relevant Codes of Conduct.
Yes
EmailsTextPhoneLetter
To allow photographs to be taken and used on the Blackburn Harriers' Website and Facebook PagesTo allow photographs to be taken and used in newspaper articlesTo allow photographs and video for individuals and groups to be taken for training purposes only
Member Signature (Parent if Under 16)*

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Date*

DayMonthYear
Date
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Name of Club*
Date Joined*

MonthDayYear
Date
Date Resigned*

MonthDayYear
Date
First Claim MembershipSecond Claim Membership
Any further information you think might be relevant to your membership:
My Products*
prevnext( X )
Senior Membership (21+) YEARLY FEE FOR 2026
Including Jotform Admin/Stripe Fee.

£66.18 Quantity



U12 - U20 Membership (SCHOOL YEAR 5 pupils and upwards) YEARLY FEE FOR 2026
Including Jotform Admin/Stripe Fee.

£61.10 Quantity



Under 10 Membership SCHOOL YEAR 3 and 4 YEARLY FEE FOR 2026
Including Jotform Admin/Stripe Fee.

£37.76 Quantity



Social Member YEARLY FEE FOR 2026
Including Jotform Admin/Stripe Fee.

£30.65 Quantity



2ND CLAIM MEMBER YEARLY FEE FOR 2026
Please select the option based on how many athletes are wishing to join

£12.40



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£0.00
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Application for Membership

Primary Emergency Contacts Details

A medical form needs to be completed for all Under 18 athletes. For Seniors, if you wish to inform us of any health issues - please add below

Medical/Welfare Information

Medical Information