Holmfirth Harriers Athletic Club

HOLMFIRTH HARRIERS ATHLETIC CLUB
Member of England Athletics & British Triathlon Association

Welcome to the leading Athletics Club in the district. We cater for runners of all ages [minimum 8 years] and abilities and enjoy a reputation as a very friendly and successful club.The Club provides forthe following disciplines, please identify your interest(s):

CROSS COUNTRY ROAD RUNNING TRACK & FIELDFELL RUNNINGTRIATHLON

MEMBERSHIP APPLICATION FORM

(to be completed in BLOCK LETTERS)

Title …………First name ……………………….……………….……Last name ………………………………………

Gender (M/F) …………………Date of birth …………………………………Age …......

Address …………………………………………….……..………………………………………………………………...

………………………………………………Post code …………………………Tel. No. .………….……………

E-mail address ………………………………………..…….……………………

Place of Birth…………………..……..…… County ………….………………..……………..

Emergency contact name & tel. no.………………………………………………………….…………………………….

Do you have a history of any medical condition which the club and/or our club coaches need to be informed of? YES/NO. If yes, please provide details:

Are you or have you been a member of an existing athletic club (Y/N)?…….. If yes, please give details of club & date

of joining/resigning:…………………………………………………………………………………………………………

I hereby apply to become a Member of the above Club and agree to abide by the Rules and Constitution of the Club. I am, as far as I am aware, fit to take part in any physical activity. A copy of the Rules and Constitution are available from the Secretary, please see website for details.
Data provided will be protected by the Data Protection Act, for Administration purposes only, under the auspices of England Athletics

Signature …………………………………….Date…………………………..

Under 18 years: Parent/Guardian details & consent:

Signature …………………………………… Relationship to athlete ………………………….. Tel. No. …………………………

Photographs of you while competing may be used for promotional purposes, if you object please indicate by ticking the box

Completed forms with correct money to be forwarded to:

HHAC Membership, 8B Oldfield Road, Honley, Holmfirth, HD9 6RL (Cheques made payable to HHAC)

PLEASE NOTE these rates include a one-off £10 joining fee.

SUBSCRIPTIONS RATES

Seniors£46.00Annual subscriptions are due on the 1st January, if you join part way

Associate£20.00throughthe year you are still required to renew your membership the

Students £32.00following January. Renewal letters are posted out to Members.

Age 11-17 £32.00Members are not eligible to compete in Club Races until they have paid

Age 8-10£27.00 their subscriptions. They must be on the Club`s Registration List to

Family £100.00compete in Championship and League events.

ACTIVITY REGISTRATION FORM

ACTIVITY DETAILS:

Activity / Holmfirth Harriers Training Sessions. / Venue / Neiley Pavilion, Honley. / Time / 7pm to 8pm

PARTICIPANT DETAILS:

Surname: / Telephone:
Address: / Postcode:
Name: / DOB: / Age: / Gender: / School:
Person 1 / M / F
Person 2 / M / F
Person 3 / M / F
Person 4 / M / F
Person 5 / M / F
Person 6 / M / F
Person 7 / M / F

EMERGENCY CONTACT DETAILS:

Name of Parent/Guardian/Contact
Emergency Contact Number
Medical conditions the coach should be aware of:
Please use back of form if more space required,

JUNIOR DETAILS:

YOU ARE RESPONSIBLE FOR DELIVERING YOUR CHILD TO THE CLUBHOUSE PRIOR TO THE SESSION. JUNIOR MEMBERS MUST NOTBE ALLOWED TO STAY ON THE FIELD FOR HEALTH AND SAFETY REASONS AND MUST REPORT TO THE CLUBHOUSE. YOU ARE RESPONSIBLE FOR YOUR CHILD UNTIL THEY DO SO BETWEEN 6.45PM AND 7.00PM.
THE JUNIOR SESSION FINISHES AT8.15pm AT THAT TIME YOU ARE RESPONSIBLE FOR YOUR CHILD’S WELFARE
Name of person authorised to collect child/children:

Signature of RUNNER (or parent/guardian for juniors): ……………………………………….

PLEASE ENSURE THE PARTICIPANT IS WEARING SUITABLE CLOTHING, AND THAT THEY HAVE ADEQUATE/APPROPRIATE REFRESHMENTS FOR THE DURATION/NATURE OF THE ACTIVITY.