Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth *

MM

DD

YYYY

Are you currently a member or have you previously been the member of another athletic club (Not applicable if joining 2nd claim) *

Yes

No

Date of resignation

MM

DD

YYYY

Have you submitted to Change of 1st Claim Club Form?

Yes

No

Do you have any medical conditions which our coaches and team managers should be aware of?

Yes

No

Do you consider yourself to have a disability? *

Yes

No

If yes, what is the nature of your disability?

Visually Impaired

Learning Disability

Hearing Impaired

Multiple Disability

Physical Disability

Other

Please tick areas of special interest *

Sprints

Hurdles

Middle distance

Long distance

Steeplechase

Throws

Long/Triple jump

High jump

Pole vault

Race walking

Road running

Cross country

Fell running

Coaching

Officiating

Name of first emergency contact *

First Name

Last Name

Name of second emergncy contact *

First Name

Last Name

I apply for membership to Gmax Trackstars and, if elected agree to abide by the Constitution of Gmax Trackstars and the Club Code of Conduct. (Constitution; Code of Conduct can be found on the club website) *

Yes

No

I do hereby certify that the details supplied under Sections A to F above are correct to the best of my knowledge. I consent to:

My child being taken away to matches under the supervision of a Team Manager and giving them permission to approve emergency first aid and other medical treatment if necessary

Emergency first aid being delivered at training venues if required

Photos/Videos of my child being used by the Club in line with Club/UKA Welfare Policies for a) use as a coaching aid and/or b) publicising or promoting the Club including publication on the Club website

The membership information being stored in accordance with the Data Protection Act

My child training outside the confines of the track, where coaching supervision may be more limited

My child going home alone after training (U15)

Name of parent/carer who is granting consent

First Name

Last Name

Date consent given

MM

DD

YYYY

One of the conditions of membership of Cambridge Harriers is that we ask all parents/carers to help at club events for a few hours each year. Please tick areas that you would be interested in helping with

Helping at Athletic Meetings

Refreshment Area

Fundraising

Website Management

Promotion & Marketing

Assisting Training

Team Management

Committee Post

Helping Officials

Arranging Social Activities