Application for Junior Membership 2017/18

Part 1 - Personal Details











Part 2 - 1st/2nd Claim Clubs

Rothwell & District Harriers 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.




Note £13 OF THIS IS PAID EACH YEAR TO ENGLAND ATHLETICS

New Members Pro-Rata (At full rate) Subject to minimum fee of £13: April to May £20, June to July £18, August to September £16, October to November £14, December to January £13. New members do not pay February to March

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 a medical consent form as well as signing up online. The consent form is available here once filled out it needs returning to KEITH PAILING or JO HESELTINE.

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 & District Harriers and shared with England Athletics. I confirm I am eligible to compete under UK Athletics Rules and agree to the Terms and Conditions. To view the Terms and Conditions