REigate priory athletic CLuB

MEMBERSHIP FORM

PLease complete all Details in Block capitals or TYPE

please read carefully and Check OUR website for guidance

section a: athlete details

Name / Male / Female
Address / Date of Birth
Postcode
Telephone* / Mobile No*
Email Address*
*Of parent/carer if athlete under 16 years of age
If you are joining from another club, please give the name of your former club / Date of Resignation
Will RPAC be your 1st claim athletic club? Y/N / If not, which will be?

SECTION B: PARENT/CARER, EMERGENCY CONTACT AND MEDICAL CONDITIONS

If you are under 16 years of age, please ask your parent/carer to complete the complete the following section.

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

diabetes, allergies, physical or learning disabilities etc.).

Please do not leave blank– if there is no information please type ‘None’., E

Name / Relationship to athlete
Emergency contact details
Please give details of any medical conditions, medication, allergies etc

It may be essential at some time for authorised persons acting on behalf of the club to have the necessary authority to obtain urgent treatment which may be required whilst at representative club competition or training. By signing below you are giving your consent to emergency treatment being given to the athlete named on this form by trained personnel.

PLEASE CONTINUE THIS FORM OVER THE PAGE

SECTION C: PARENT/CARER/VOLUNTEER HELP

One of the conditions of membership of RPAC is that all members, parents and carers help with club activities. Please tick any areas that you would be interested in helping with. This could include an area in which you already have experience, or you would like to get involved in, for which the club can arrange appropriate training. The relevant club person will then contact you. If there is another specific area of expertise that you feel you can bring to the club, please also indicate in the ‘Other’ space.

Helping at athletic meetings (marshalling etc.) / Assisting at Training / Learning to Coach
Team management or supervision of athletes / Becoming an Athletics Official
Communications / Information Technology
Social events or fund raising / Committee (contact Paul Chandler for more details)
Other (please specify)

section D: Membership category (SEE THE CLUB WEBSITE FOR MORE DETAIL)

Category / Tick / Annual Fee / EA membership / Club vest
(new members) / Total
Junior Academy / £15 / £13 if 11 and over / £15 / £30 or £43
Junior Under 11 / £20 / N/A / £15 / £35
Junior Under 18 / £25 / £13 (mandatory) / £15 / £53
Senior First Claim / £35 / £13 (mandatory) / £15 / £63
Senior Second Claim / £18 / N/A / £15 / £33
Veteran over 65 / £15 / £13 (mandatory) / £15 / £43
Family (at one address) / £75 / £13 per runner / £15 per runner
Associate (non-runner) / £5 / N/A / N/A / £5

section E: Athlete AGREEMENT

By returning this completed form, I confirm that I have read the RPAC Membership Pack and am willing to abide by the club code of conduct for athletes/junior athletes and agree to always behave in the manner befitting an RPAC Athlete.

Signature
Print Name

section F: PaRENTAL/carer AGREEMENT (PLease ignore if athlete over 16 years of age)

By returning this completed form, I agree:

1. To the named athlete taking part in the activities of the club, including competing for the club.

2. That I have read and agree to abide by the club code of conduct whenever I am present at club activities or competition.

3. To volunteer in some capacity for the club and assist at RPAC events each year.

Signature
Print Name

section G: junior coach Approval (PLease ignore if athlete over 16 years of age)

This form must be approved by one of the junior coaches before submission to the Membership Secretary.

Coach Name…………………………………………. Signature………………………………………… Date………………