Membership: Family (One Parent Member with up to 3 Junior Members)

Application for Membership 2021 (One Parent Member with up to 3 Junior Members)

(If you need another type of membership, click here )

You may join online by filling in the form below, which will then take you to PayPal for paying your subscription securely using a credit or debit card
(You do not need to be a member of PayPal).

SUBSCRIPTIONS RUN FOR 12 MONTHS FROM 1st APRIL 2021 £28.00

We will use this information to ensure that you are kept informed about club events. Please be aware that £15 of your membership fee is forwarded to England Athletics and you should receive an EA Competition Licence in due course. You may require your registration number to enter races.

Type of membership

New Member

Renewal

Existing members click on the "renewal" button.

Helping the club *

Bungay Black Dog Running Club hosts a number of external club events throughout the year and seeks ongoing support from its membership in the planning, organisation and implementation of those events.
All members are required to help support one or more of our races each year. To affirm your contribution and support and to ensure the ongoing success of those events,please indicate below at which BBDRC race(s) you will help.
All race dates are subject to change
.

Groggy Doggy - 26th December 2021

Summer Series 10k – Race 1 (Date to be confirmed June 2022)

Summer Series 10k – Race 2 (Date to be confirmed June 2022)

Summer Series 10k – Race 3 (Date to be confirmed July 2022)

Title

eg Mr, Mrs, Miss etc

Name

Name of Parent (including surname)

Address

Post Code

Mobile Phone

Home Phone

Date of Birth (YYYY-MM-DD)

Occupation

Emergency Contact Details

Please insert the information below to indicate the person(s) who should be contacted in event of an incident/accident.

Emergency Contact name for Senior Member (e.g. spouse, parent)

Emergency Contact Phone

Disability

Do you have a long term health condition or impairment that limits your daily activities?

Yes

If yes, please specify below

Sporting information

Have you been Running before?

Yes

Medical information

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

First Junior Details

Title of First Junior

eg Mr, Miss etc

Name of First Junior (inc Surname)

First Junior Date of Birth (YYYY-MM-DD)

Do you have a long term health condition or impairment that limits your daily activities (First Junior)?

Yes

If yes, please specify below

Second Junior Details

Title of Second Junior

eg Mr, Miss etc

Name of Second Junior (inc Surname)

Date of Birth of Second Junior (YYYY-MM-DD)

Do you have a long term health condition or impairment that limits your daily activities (Second junior)?

Yes

If yes, please specify below

Third Junior Details

Title of Third Junior

eg Mr, Miss etc

Name of Third Junior(inc Surname)

Date of Birth of Third Junior (YYYY-MM-DD)

Do you have a long term health condition or impairment that limits your daily activities (Third Junior)?

Yes

If yes, please specify below

Parent Helper Role

I agree to undertake the role of parent(s)/helper to support the junior membership at least once a term. I would prefer:-

Mondays

Thursdays

Either

Please Indicate your Preference

Photography

From time to time the club may take photographs for publicity purposes. Please indicate below if you consent to the club taking and using such photographs.

Yes

First Aid

In the event of a medical emergency, a qualified member of the club may be required to administer first aid. By submitting this form you agree to such action being taken by the club.

Confirmation

I confirm my agreement to the following as part of my application to renew my membership of Bungay Black Dog Running Club.

I wish to renew my membership of Bungay Black Dog Running Club (BBDRC). I will abide by the BBDRC Senior Athletes Code of Conduct and the Rules for Competition as determined by British Athletics.

General Data Protection Regulation

We take the protection of your data very seriously. We use the information on this form on the basis that:

1. In signing this form you have given your consent to the use of your data

2. The information is necessary in order to protect your vital interests while undertaking activities within the club

3. The information is used in the legitimate interests of ensuring BBDRC is run safely and effectively for all members

Your information may be shared within the club for the purposes of club administration, event management, coaching and safety.

Sharing with Third Parties

BBDRC will never share or sell your data to any third party other than England Athletics. When you become a member of or renew your membership with Bungay Black Dog Running Club, you will automatically be registered as a member of England Athletics. We will provide England Athletics with your personal data which they will use to enable access to an online portal for you (called myAthletics). England Athletics will contact you to invite you to sign into and update your MyAthletics portal (which, amongst other things, allows you to set and amend your privacy settings). If you have any questions about the continuing privacy of your personal data when it is shared with England Athletics, please contact dataprotection@englandathletics.org.

I agree to my data being shared with England Athletics

Yes

I agree to that my email address can be shared with other parents/carers in order to facilitate the effective and efficient management of the Junior Helpers' Rota

Yes

Equality

Sport can and does play a major role in promoting inclusion of all groups in society. However, inequalities have traditionally existed within sport, particularly in relation to gender, race and disability. Sport England is committed to promoting and developing sports equalities and taking steps to agree them.

Navigation

Application for Membership 2021 (One Parent Member with up to 3 Junior Members)

Emergency Contact Details

Disability

Sporting information

Medical information

First Junior Details

Second Junior Details

Third Junior Details

Parent Helper Role

Photography

First Aid

General Data Protection Regulation

Sharing with Third Parties

Equality