Aylsham Runners Membership Form

Aylsham Runners Membership Form

Aylsham Runners & England Athletics
Thankyou for choosing to join our club, we look forward to welcoming you and your family. We are an athletics/running club open to athletes of any ability.

To ensure we have the correct contact details for you, please fill out this form. This includes medical and other information required for registration with England Athletics.
SECTION A - Member Details
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Phone Number
Mobile Phone Number
Email*
Date of Birth*

DayMonthYear
Member's DOB
Current Date*

DayMonthYear
Date
Age*
What is your sex? (required for competition)*

MaleFemale
Prefrerred Pronoun
So, we know what to call you (eg. he/him, she/her, they/them)
SECTION B - Parent/Carer Details

If you are under 18 years of age, please ask your parent/carer to complete this section.
Name

First NameLast Name
Address - if different from SECTION A above

Street Address

Street Address Line 2

CityCounty

Postcode
Phone Number
Mobile Phone Number
Email
This is a required field, so England Athletics can invite you to access your MyAthletics portal to complete the registration process with them.

SECTION C - Emergency Contact Details

Please insert the information below to indicate the persons who should be contacted in event of an incident/accident.
Emergency Contact Name*
Relationship to You*
Contact Tel Number*
Landline or mobile
SECTION D - Medical Information

Please detail below any important medical information that our leaders or coaches should beaware of. This will help us support you during club activities.
Do you have any specific medical conditions? (e.g. epilepsy, asthma, diabetes, allergies, etc.)*

YESNO
If YES, please provide details (including any medication required)...
eg pills, inhaler, diabetes
Do you have any health conditions that might prevent you taking part in training?*

YESNO
If YES, please provide details...
Do you have any allergies?*

YESNO
If YES, please provide details...
SECTION E: ADDITIONAL SUPPORT

Please detail below any additional support you may require.
If you are disabled, please include any relevant information here:
Data Consent*

I consent to my personal data provided in SECTIONS C, D and E to be shared with the relevant club personnel for the purposes of the delivery of my safe participation in club activity. This data will not be shared or processed for any other purpose

SECTION F - Photography & Video Consent

Aylsham Runners recognises the need to ensure the welfare and safety of all club members. We will not permit photographs, video or other images of club members without consent. For children Under 16, consent must be provided by their parent or carer. We 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.
Please tick all that apply:

I give permission for my photograph/video to be used within the club for display purposes or within other printed publications.܆I give permission for my photograph/video to be used on the club’s website and social media pages.܆I give permission my photograph/video to be used for training or analysis purposes
SECTION G - Club Privacy Statement & Communication Preferences

Please read the full privacy notice carefully to see how we will treat the personal information thatyou provide to us. We will take reasonable care to keep your information secure and to preventany unauthorised access.
Please tick all that apply:

I confirm that I have read and understood the privacy notice and how data will be used andsharedI would like to receive Information via email from the Club about specially selected products and services available from commercial sponsors and partnersI am happy to receive communications via SMSI am happy to receive communications via Post

Annual Membership Fee - secure online payment via Stripe

Aylsham Runners - Membership Product Image

Aylsham Runners - MembershipMembership runs to 31st March

£35.00

Total

£0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

By clicking SUBMIT you are effectively confirming as the Member (or Parent/Guardian of the member) that the information provided in this form is correct.
Should be Empty:

Aylsham Runners Membership Form

SECTION A - Member Details

SECTION B - Parent/Carer Details

SECTION C - Emergency Contact Details

SECTION D - Medical Information

SECTION E: ADDITIONAL SUPPORT

SECTION F - Photography & Video Consent

SECTION G - Club Privacy Statement & Communication Preferences