Athletics Membership Form Athlete Details Membership Subscription Health Form Order Number Application Type New Member Renewal Last Name * First Name * Gender * Male Female Address * Address Town * County * Postcode * Telephone * Mobile If no landline number, enter mobile number instead in Telephone field Email * Date of Birth (dd/mm/yyyy) * County of Birth * Emergency Contact Name * Emergency Contact Telephone (during training sessions) * First claim UKA affiliated club if not WVAC Preferred Athletic Discipline * Sprint/Field Endurance/Field All Disciplines I hereby apply for my child to be a member of Waveney Valley Athletic Club and agree that both myself and my child will read the Clubs Welcome Pack and abide by the Club’s Codes of Conduct within as displayed on www.waveneyvalley.org I understand WVAC train to compete, and agree to compete for the Club in competitions if requested and I will help officiate at these competitions when in attendance. I further agree that we will abide by the rules of the Governing Body of Athletics and agree that my child is an amateur as defined by them. My child is, as far as I am aware, fit to take part in strenuous physical activity. Signed (applicant) * Parent/guardian (if applicant is under 18) * Relationship to the applicant * MEMBERSHIP SUBSCRIPTION 2021/22 Covers UKA affiliation only :-£15Membership will revert to normal fee structure for 2021–22 Price for 1 Member (with UKA Fees) £30 Price for 3 Members (with UKA Fees) £76 Price for 2 Members (with UKA Fees) £54 Price for 4 Members (with UKA Fees) £98 These costs include the annual £15 UKA affiliation fee per person which Waveney Valley Athletic Club will forward on your behalf).This is for athletes aged 11 by 31/03/22 If your child is not aged 11 before 31/03/21please deduct £15 from your membership subscription fees above All fees must be paid by Standing Order only Monthly Training Fee: £10 or Upfront Annual Fee: £100 Our bank details are: Santander: Waveney Valley Athletic Club Sort Code: 09-01-29 Account No: 21206227 Please give your child’s name as the reference so we know who the payment is from, all payments are non-refundable. Amount paid: £ * Payee Name/Ref: * Date: If you would like to opt in to the WVAC Whats’app group for the latest updates, please give your Mobile Number: If you do not wish your child/children’s photograph(s) to be used for publicity, on promotional literature, the club website or social media sites please sign here: Please note that all officiated competitions are registered on the Power of 10 website HEALTH FORM 2021/22 Last Name * First Name * PLEASE ANSWER THE FOLLOWING QUESTIONS Does your child have any allergies?If the answer is “yes” then please state type of allergy and medication/treatment required: If the answer is “yes” then please state type of allergy and medication/treatment required: Allergies Yes No Does your child have Asthma?If the answer is “yes” then please state the type of medication and/or treatment given: If the answer is “yes” then please state the type of medication and/or treatment given: Asthma Yes No Does your child have any other conditions, or any additional or special needs the club should be aware of?If yes, then please state the condition and the medication/treatment required, or detail the additional or special needs: If yes, then please state the condition and the medication/treatment required, or detail the additional or special needs: Other Condition Yes No Medical information bands are available from the Club, at a subsidised cost of £10 each. If any condition and or medication changes you must inform your Coach and/or the Membership Secretary immediately. If you have any concerns regarding your child’s health, please check with your doctor before he/she starts to train or resumes training following illness. I understand that in the case of a medical emergency arising with my child every effort will be made to obtain my consent to treatment, but if this proves impossible I authorise the Club to act in loco parentis. Signed (applicant or guardian if under 18) * If guardian, relationship to the applicant: * Date: Date: