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Woodford Green AC with Essex Ladies is formed as a Community Amateur Sports Club and is open to all who are interested in Athletics.

 

 DATA PROTECTION: We are required by England Athletics to share this data for registration purposes. Please refer to the Privacy Policy on our club website.
  MEMBERSHIP: for WASPS & Special Members
  Please select a yearly membership subscription below:

Please make a selection.

 

  MEMBERSHIP APPLICATION

 

Please enter athletes first name.

Please enter athletes last name.

Please enter a contact number.

Please enter a contact email address.

Please enter athletes town & county of birth.

Please enter a street address.

Please enter a city.

Please enter a county.

Please enter a postal code.

Please enter the date.

Please enter athletes school.
Are you:

Please make a selection.
Events Interested in

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Please enter athletes event performance.
Do you have a coach?

Please make a selection.
Would you like coaching?

Please make a selection.

Please enter name of coach.
Have you been, or are you a member of any other club affiliated to UKA/EA?

Please make a selection.

Please enter the name of club.

Please enter UKA/EA registration number.
Have you completed the Application to Change Club at <a href="http://www.englandathletics.org/myprofile" target="_blank">englandathletics.org/myprofile</a>

Please make a selection.
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  EMERGENCY / GUARDIAN CONTACT
  It is important that we have up-to-date information of an appropriate person who can be contacted in an emergency.

Please enter emergency contact's / guardian's name.

Please enter emergency / guardian's number.

Please enter emergency / guardian's address.

Please enter emergency / guardian's email.

Please enter emergency contact's / guardian's relationship to athlete.

 

  MEDICAL INFORMATION
Does the athlete have any medical conditions?

Please make a selection.

Please enter medical condition.
Has the athlete been immunised against tetanus?

Please make a selection.
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Does the athlete use an inhaler?

Please make a selection.
Is the athlete able to use the inhaler without supervision?

Please enter make a selection.

Please enter type of inhaler.

 

  DECLARATION
  Please note:
  1. You must sign the declaration and complete the form in full.
  2. The completed forms will be sent to the Membership Secretary and stored securely online.
  3. You agree to abide by the club code of conduct whenever you are present at club activities or competitions.

Please select all to continue

Please select all to continue

Please select all to continue

Please select all to continue

Please select all to continue

  Please date and sign below:
 If the athlete is under 16, this must be signed by a guardian.

Please enter the date.

Please print name and sign.
Sign Above

Please sign here.

 

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