Application for Junior Membership 2022/23

Part 1 - Personal Details

Part 2 - 1st/2nd Claim Clubs

Rothwell Harriers & A.C. is:

Part 3 - Resignation from Previous Club/s

Are you currently resigning or have you recently resigned from another running club

Part 4 - Fees

Fees are payable by the 1st April each year. See below if joining through the year.


New Members Pro-Rata (At full rate) Subject to minimum fee of £25: March to May £25, June to July £25, August to September £25, October to November £25, December to January £25. New members do not pay February.

Part 5 - Recorded Photography and Images Consent

Part 6 - Medical Consent

If your child has any medical conditions coaches need to be made aware of you will need to fill out the fields below.

By ticking this box I confirm My child is in good health and I consider him/her capable of taking part in athletics. If I am in doubt of my child's health I will speak with their GP/consultant and gain their agreement for my child to undertake physical activity. I will not bring my child to training if they have an illness or injury that will impact on their ability to be included in activity.

I consent that, in the event of any illness/accident, any necessary treatment can be administered to my child, which may include the use of anaesthetics, which are necessary in the opinion of a medically qualified practitioner. I also understand that, whilst Club/Coaching Personnel will take every precaution to ensure that accidents do not happen, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child.
By ticking this box, I consent to the information I have given, being used by Rothwell Harriers & A.C. and shared with England Athletics as described in the Data Protection Statement . I confirm I am eligible to compete under UK Athletics Rules and agree to the Terms and Conditions. To view the Terms and Conditions