Membership Application (Juniors) – Crowborough Runners

Crowborough Runners Junior Membership Application

The safety and welfare of children in our care is paramount, and it is therefore important that we are aware of any illness, medical condition and other relevant health details in order that their best interests are always addressed. Please complete this form with our assurances that the information will be treated as confidential. It is the responsibility of the junior and their parent/guardian to notify Crowborough Runners if any of the details change at any time.

"*" indicates required fields

Child's details

Name*

First name Surname

Address*

Address 1 Address line 2 Town County Postcode

Date of Birth*

Parent/Guardian's details

Name (Parent/Guardian 1)*

Title First name Surname

Is Parent/Guardian 1's address the same as Child's address?

Yes

Address*

Address 1 Address line 2 Town County Postcode

Mobile

Landline

Email*

Other Parent/Guardian?

Yes

Name (Parent/Guardian 2)*

Title First name Surname

Is Parent/Guardian 2's address the same as Parent/Guardian 1's address?

Yes

Address*

Address 1 Address line 2 Town County Postcode

Mobile

Landline

Emergency Contact details (in addition to Parent/Guardian)

Please ensure they know they have been named.

Name (Emergency Contact 1)*

Title First name Surname

Relationship to child*

Contact number

Is there a second Emergency Contact?

Yes

Name (Emergency Contact 2)*

Title First name Surname

Relationship to child*

Contact number

Medical Information

Name of child's Doctor*

Title First name Surname

Address of Doctor's Surgery*

Address 1 Address line 2 Town County Postcode

Telephone number

Does your child experience any conditions requiring medical treatment/and or medication?*

Yes

Please give details below including medication dose and frequency*

Does your child have any allergies?*

Yes

Please provide details*

Does your child have any specific dietary requirements?*

Yes

Please provide details*

Does your child have any additional needs?*

(for example: planned medication, assistance with lifting or access, regular snacks)

Yes

Please provide details*

The Equality Act 2010 defines a disabled person as "anyone with a physical or mental impairment, which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities."

Do you consider your child to have a disability?*

Yes

What is the nature of their disability*

(select all appropriate categories)

Visual Impairment

Hearing Impairment

Physical Disability

Learning Disability

Multiple Disabilities

Other

Does your child have any communication needs?*

(for example: non English speaker/hearing impairment/sign language user/dyslexia)

Yes

What do we need to do to enable him/her to communicate with us fully?*

Medical confirmations

Consent

Please tick where appropriate, your consent and acknowledgement of the following statements:

We occasionally take pictures of our juniors taking part in training and various events such as cross-country races and park runs etc. We would like to use these pictures in our Club newsletter and /or the Junior section of the Club’s website, which can only be accessed by members. Please indicate below whether you do or do not want your child’s photograph to be used in this way.

Photography consent*

Do you consent to photographs of your child at races and in training being included in the Club’s newsletter or on the Club’s website?

Yes

Register of attendance:

As a Club we are committed in providing a safe, effective and ‘child-friendly’ environment. It is therefore our policy that all athletes under the age of 16 to be signed in at the start of the training sessions and signed out at the end by a parent or guardian.

As a parent/guardian you have the option, if you wish to give us permission for your child to be able to sign themselves ‘in and out’ and to arrive and leave independently. If appropriate please fill in accordingly:

Part 1 - Independently*

To arrive and leave independently and to sign him/herself in and out of the register for all training sessions.

Yes

Part 2 - Drop off/Collection*

To be dropped off and collected occasionally by a nominated adult.

Yes

Name of nominated adult*

Title First name Surname

Contact number*

Email*

Payment

Annual junior membership fees are £38 per year and the Club’s financial year runs from 1st April to the subsequent 31st March. The £38 fee covers a personalised tee-shirt for your child on joining, the costs of renewal of training equipment, the ongoing training of our volunteer coaches and advice from the Club about race opportunities throughout the year.

By applying for your child to join the junior section of the Club, you will be sent an email from noreply@EnglandAthletics.org inviting you to pay the subscription fee online by debit or credit card using Stripe, the secure online payment gateway for the Club arranged via England Athletics.

Completed signed and dated membership forms should be sent by email to the Club Membership Secretary, Ron Cutbill ron.crowboroughrunners@btinternet.com and the Club Treasurer, Sarah Hilliard sjhilliard@yahoo.com.

It is the responsibility of the junior and their parent/guardian to notify Crowborough Runners if any of the aforementioned details change at any time.

Signature (Parent/Guardian 1)*

Please draw your signature into the box provided (don't worry if you cannot exactly match your written signature with this electronic version).

Signature (Parent/Guardian 2)*

Please draw your signature into the box provided (don't worry if you cannot exactly match your written signature with this electronic version).

Date*

Human verification