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

Application for Membership 2019 (One Parent Member with up to 3 Junior Members)

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

Please fill out your contact information below.

SUBSCRIPTIONS DISCOUNT FOR LAST 5½ MONTHS FOF SUBS YEAR TO 1 APRIL

£23.00 (Usually £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.

Title

eg Mr, Mrs, Miss etc

Name of Parent (inc Surname)

Address

Post Code

Mobile Phone

Home Phone

Date of Birth

Occupation

Name of first junior (inc Surname)

Date of Birth of first junior

Name of second junior (inc Surname)

Date of Birth of second junior

Name of third junior (inc Surname)

Date of Birth of third junior

Helping the club

I agree to help at BBDRC events if and when requested or should I choose to take part in any BBDRC event, then I agree to help and or provide help from a friend and/or family member.

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. Please affirm below your contribution and support and to ensure the ongoing success of those events.

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

Whilst it is not compulsory that the following section is completed the note below explains why it is important.

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.

Disability

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 yourself to have a disability?

Yes

If yes, please specify in box below

Please detail below any important medical information that our coaches should be aware of

Visual impairment

Hearing impairment

Physical disability

Learning disability

Multiple disability

Other (specify below)

Sporting information

Have you been running before?

Yes

Medical Information

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

Medical Information and name of person

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.

Data Protection Act

Your details are stored on a computer and shared with England Athletics for Registration purposes only.

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

Contact number

Confirmation

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

I wish to join/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

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

Navigation