Please provide a contact name and number of someone who we can contact in case of an emergency.
The following form must be completed. For athletes under the age of 18, this must be done by a parent/guardian. Please state the name of the person filling in this form and your relationship to the named athlete.
England Athletics Affiliation Number (Competition License Number)
Have you previously belonged or do you currently belong to any other Athletics Club? If yes, please state which club and date of resignation.
If applying for First Claim Membership AND you / your child are a member of another Athletics Club you must compete a Change of First Claim Club Form which can be downloaded from England Athletics Website, to formally resign from your previous Club. This will allow us to register you as a Cleethorpes Athletics Club member with England Athletics - have you completed this? (Enter Yes / No)
Please give details of any disabilities, medical conditions, health matters or allergies that might affect you / your child whilst taking part in activities, including any medication. If no known information, please state NONE. Failure to provide information will result in the club assuming that there are no conditions or medication being taken.
It may be essential at some time for authorised persons acting on behalf of the club to have necessary authority to obtain urgent treatment that may be required whilst at representative club competition or training. Do you give consent to a representative of the club to authorise any necessary treatment? (Enter Yes/No)
Cleethorpes A.C. cannot be held responsible for the transit of your child to and from the car park/pick up point. We advise all parents to ensure that their child is accompanied safely to the necessary drop off point and is not left alone until their coach arrives. Please ensure that your child is picked up at the correct time. Will your child be collected from the drop off point? (Enter Yes/No). If yes, who is authorised to collect your child?
Please give an alternative emergency contact (State: Name, Relationship, Telephone Number).
Name of lead coach:
Do you give consent to Cleethorpes Athletics Club taking and using photographic and video media of you / your child for marketing and promotion purposes, including publishing on the club website?
Terms and conditions of membership
*By registering as a member of Cleethorpes Athletics Club you are hereby accepting the Club Code of Conducts for Athletes and Parents which can be found on the club website or is available upon request. You are agreeing to the minimum expectations for terms of membership which can be found on our club website.
You are also declaring that the following statements are true:
I / my child is in good health and is capable of taking part in athletics.
I / my child is eligible to compete for Cleethorpes Athletics Club in accordance with UKA Rules.
I understand that my / my child’s personal data will be stored electronically and a paper form will be stored for coaches to access. This will only be used for the purpose of administration as required by the club and will only be accessible by club officials and coaches.. I also understand that as a competing member, that data will also be shared and held by England Athletics.
I have read and agree to comply with UK Athletics and Cleethorpes AC Code of Conduct for Athletes and Parents which can be found on the club website.
I agree to the minimum competition obligations set out by the Track and Field Committee which can be found on the clubs website.
I agree to notify the club and coaches of any change to personal details and medical information.
I understand that in the event or my / my child's resignation from the club, any monies or equipment owed to the club must be returned.
Cleethorpes Athletics Club are not under any liability whatsoever in respect to personal injury, loss or damage caused when you / your child are attending club sessions or representing the club at any competition.
I agree with the disclaimer as described above. Refund Policy
*Unfortunately we do not offer a refund on membership fees for early resignation or leaving within the membership year.
We also do not offer refunds for any athlete failing to meet the minimum expectations outlined in the clubs code of conducts and terms of membership. The clubs membership policy can be found on our website.
I agree with the refund policy as described above. Security Question
*What number is between 103 and 105?
Enter answer here.