Membership Form

HONITON RUNNING CLUB JUNIORS MEMBERSHIP FORM

We are very pleased to welcome you to the HONITON RUNNING CLUB JUNIOR SECTION

To ensure we have the correct contact details for you, please fill out this form. It will be sent to Tony Peek, the Juniors secretary when you click the Submit button. Please sign the form by typing in both parent's and junior's names at the bottom. We take these as equivalent to written signatures. We will also use this information to ensure that you are kept informed about club events.

Honiton RC Juniors Membership Form

* Indicates required field

Name of Junior *

First

Last

Address1 *

Town/Village *

Parent's Email address *

Address2 *

Post Code *

Phone (land line) *

Mobile (Parent 1) *

Mobile (Parent 2) *

DOB (Junior) *

School *

Disability/Medical

The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial long-term adverse effect on his or her ability to carry out normal day-to-day activities.

Do you consider your son/daughter to have a disability? *

Yes No

If YES, what is the nature of the disability? *

Please detail below any important medical information that our coaches should be aware of (e.g. epilepsy, asthma, diabetes etc.)

If Other please give details *

Sporting Information

Have you participated in running as a sport before? *

Yes No

If YES where? *

Primary Secondary Club County

Emergency contact details

We will use the contact information above in event of an incident/accident, or you can specify another adult contact and phone number here.

Emergency Contact *

Emergency phone number *

Photographs - see code of practice in Welcome Pack

I consent to my son/daughter being photographed *

Yes No

Contacting Parents

Our normal method of contact is by email. We also send information leaflets home via the junior particularly to do with races or special club activities. Information will also be on this website, which includes a calendar of events so please check this once a week.

Declaration

By returning this completed form, I agree to my son/daughter/child in my care taking part in the activities of the club. I understand that I will be kept informed of these activities – for example timing and transport details. (This website is the main source of information about the club and should be visited regularly by the junior.)
I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately.
I have read the Welcome Pack and agree to the code of practice for Parents/Carers
I will take the £5 joining fee to a club night.

DATA PROTECTION : I Agree to my email address & details being held by Honiton Running Club,

Junior - I have read and agree to the code of practice for Junior Members

Signed Parent *

Signed Junior *

Date *

Submit