Junior - Louth Athletic Club Membership Form

Louth Athletic Club Membership Form

Apply or renew as a JUNIOR or as a parent/guardian on behalf of a JUNIOR. Please complete all required fields below.
New membershipMembership renewal
I am a Junior Athlete (16 to 19 years old incl.)I am a parent/guardian completing this form for a Junior Athlete (under 16)

Personal Details

Junior (16+)
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Email Address*
Mobile Number*
Address*

Street Address

Street Address Line 2
Town / CityPost Code
Your England Athletics URN (Unique Registration Number) if known:

Personal Details

Parent/guardian for Junior
Junior's Full Name*

First NameLast Name
Junior's Date of Birth*

DayMonthYear
Date
Junior's Address*

Street Address

Street Address Line 2
Town / CityPost Code
Junior's England Athletics URN (Unique Registration Number) if known:
Parent/guardian's Email Address *
Parent/guardian's Mobile Number*

In Case Of Emergency Contact & Relevant Medical Information

All Juniors
1. Primary Emergency Contact*

First NameLast Name
Mobile Number*
Enter landline (incl area code) if no mobile number
Relationship to Junior*
2. OPTIONAL Secondary Emergency Contact

First NameLast Name
Mobile Number
Enter landline (incl area code) if no mobile number
Relationship to Junior
Details of any medical conditions/required medication relevant to Junior's participation in club activities/events: *
If none enter N/A

Membership Type and Fee Payment

All members
Competitive Athlete - Louth AC membership (£30) + England Athletics registration (£23)Social Athlete - Louth AC membership only (£30)
- You can find more information on Competitive and Social Athletes in the Guidance Notes
- Juniors under 11 do not require EA registration to compete
- In addition to membership/EA fees, all junior members will be charged £2 a session training fee. This will go towards the hire of the school training facilities and new club equipment.
Your fee payable is:
Family member discount:

If this application is for one of three members from the same family (any combination of Seniors and Juniors) you enjoy a 10% discount off the Louth AC membership. So please deduct £3 from your fee payable above.
How to pay:

Please make payment by bank transfer immediately upon submitting your application form to the following:

Account name: Louth Athletic Club

Sort Code: 77-72-12

Account number: 00013039

Payment reference: Name of athlete

Member Declaration:

For Juniors (16+)
Please read and accept the declaration below prior to submitting your membership application:
- I accept that Louth Athletic Club shall not be liable for any accident, injury, loss or damage as a consequence of my membership in Louth Athletic Club.
- I accept that every person participating in club activities/events does so at their own risk. I take full and complete responsibility for my own actions.
- I am medically fit to take part in club activities/events and will take my health, fitness and experience levels into account on a continual basis.
- I agree to notify the club of any changes to my personal details and health status.
- I take full responsibility for my own safety and will either carry In Case of Emergency (ICE) contact details and relevant medical information on my person during club activities/events or provide them to Coaches prior to participation. I will also provide Coaches with such medication as required and give them authority to use it, at their discretion, should the need arise.
- I am not a member of another club affiliated with England Athletics.
- I consent to my personal data being shared with the relevant club personnel for the purposes of administration and the delivery of my safe participation in club activity.
- I consent to the club passing my personal details to England Athletics for the purpose of updating the myAthletics portal.
- I am willing to help the club by volunteering at club activities/events/maintenance sessions.
- I have read and agree to abide by the Club Rules & Codes of Conduct

Member Declaration:

By Parent/guardian for Junior
Please read and accept the declaration below prior to submitting your membership application:
- I accept that Louth Athletic Club shall not be liable for any accident, injury, loss or damage as a consequence of my membership in Louth Athletic Club.
- I accept that every person participating in club activities/events does so at their own risk. I take full and complete responsibility for my own actions.
- I am medically fit to take part in club activities/events and will take my health, fitness and experience levels into account on a continual basis.
- I agree to notify the club of any changes to my personal details and health status.
- I take full responsibility for my own safety and will either carry In Case of Emergency (ICE) contact details and relevant medical information on my person during club activities/events or provide them to Coaches prior to participation. I will also provide Coaches with such medication as required and give them authority to use it, at their discretion, should the need arise.
- I am not a member of another club affiliated with England Athletics.
- I consent to my personal data being shared with the relevant club personnel for the purposes of administration and the delivery of my safe participation in club activity.
- I consent to the club passing my personal details to England Athletics for the purpose of updating the myAthletics portal.
- I am willing to help the club by volunteering at club activities/events/maintenance sessions.
- I have read and agree to abide by the Club Rules & Codes of Conduct
Parent/guardian's Full Name*

First NameLast Name

Please now submit your Membership Application below
Should be Empty:

Rows	YES	NO
Any photographs or videos including images taken at club activities to be used for publicity and to promote the club in print and digital media.
Any photographs or videos including images taken at club activities to be used for training or analysis purposes.
The club recording and publicising race results for the purposes of publicity and for internal club competitions in print and digital media.
My personal data to be used for sending information about promotions and offers from sponsors.
My personal data to be used for sending information about selling kit, merchandising or fundraising.

Louth Athletic Club Membership Form

Personal Details

Personal Details

In Case Of Emergency Contact & Relevant Medical Information

Louth AC Privacy Policy

Photography, Video, Marketing & Communication Consent

Membership Type and Fee Payment

Member Declaration:

Member Declaration: