Junior/Child Membership Application Form 2017 To be signed by Parent/Guardian for junior/child under 18 years of age. I wish to apply for 2017 membership of Motherwell Athletics Club (MAC) for my child. I understand that membership is subject to a Standing Order being set up for £5 a month to cover weekly training fees. I understand the subscription fee is due now and is returned if the application is declined.

Applicant’s Details Name Date of Birth Gender

Male/Female

Home address (including postcode)

*Email (Parent) Home Phone Number *Mobile Phone Number (Parent) Scottish Athletics Number Doctor’s Name Doctor’s Address Doctor’s Telephone Number Allergies or Medical Conditions (including medication) Please note the use of inhalers should be registered with UK Athletics in compliance with their anti-doping policy. The form can be downloaded from http://www.motherwellac.com/welfare.shtml

Other relevant information (e.g. dietary requirements, cultural needs) *MAC may occasionally send relevant information/announcements via text message or email to the contact details provided

Emergency Contact Details Primary Contact

Secondary Contact (if Primary unavailable)

Name Relationship to Member Address (if different to above)

Daytime Phone Number Evening Phone Number Mobile Phone Number

Membership Fees 2017 The membership year is 1st January to 31st December 2017. Existing memberships are deemed lapsed if not renewed by 1st March 2017. New members joining from September 2016 onwards are covered for 2017 membership. Cheques made payable to “Motherwell Athletics Club”.

www.motherwellac.com

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Please tick

Membership Type

Cost

First-claim Junior (age 13-17 on 01/01/17)

£15

First-claim Child (age 12 or younger on 01/01/17)

£10

Second-claim Junior or Child

£10

* A 25% discount is applied to the cost of each family member where there is a minimum of three first-claim members and this must include at least one senior.

Other Athletic Clubs If applying to join as a second-claim member, please provide the name of your first-claim club

........................................................................................... NB. Second-claim members are welcome to train with MAC and take part in club social events. However, only first-claim members qualify for points/places in internal club competitions or may compete in open competitions on behalf of MAC (unless by prior agreement of the management of both clubs and the event organisers). First-claim members will always have priority in team selection.

New first-claim members receive a running vest in MAC colours. Please circle your vest size. Age 78

Age 910

Age 11-12

Age 13-14

Ladies size 6

Ladies size 8

X-Extra Small

Extra Small

Small

Sizing can be amended when the vest is supplied

Declaration 

I and my child agree to abide by the rules and Codes of Conduct of the Club as detailed in the Constitution and those of Scottish Athletics and UK Athletics;



My child is in good health and I consider them capable of participating in Club activities;



I undertake to inform the Club of any changes in my child’s health or medical circumstances which may affect their ability to take part in Club activities;

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I consent that, in the event of illness/accident, any necessary treatment can be administered to my child (which may include the use of anaesthetic) which is considered necessary in the opinion of the medical authorities present;



I understand that, whilst Club personnel will take reasonable precautions to ensure accidents do not happen, the Club cannot necessarily be held responsible for loss, damage or injury suffered by my child during Club activities;

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I undertake to inform the Club of any changes to the details I have provided, in particular the Emergency Contact details;

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I consent that the Club may use images of my child from photographs or video footage obtained during Club related activities for training purposes, publicity purposes, Club literature or on the MAC website.

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I understand my child may be asked to compete at venues which require him/her to travel. I give my consent for MAC to make such travel arrangements as are necessary, and for my child to compete at such venues;

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I give my consent for my child to participate in group training sessions with older athletes from MAC;

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I understand that the Club may, in consultation with me, obtain and make use of personal information about my child to enable an Athletic Development Plan to be compiled to help ensure that the activities my child participates in are appropriate for their age, maturity, experience and ability.

All information given is collected and processed in accordance with the Data Protection Act 1998. The only persons with access to this information are MAC coaches, welfare officer(s) and appropriate club officials.

Signed ___________________________ Print name ___________________________

Relationship to member ___________________________Date____________________

Please return this form to the Club Secretary or any Committee Member.

Official Use Only Date received Payment received Accepted/Declined Election date

Motherwell Athletics Club www.motherwellac.com

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