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.

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  MEMBERSHIP: for Active Paying Members

  Please select a yearly membership subscription below:

Active Members (Under 21) 53.00 GBP + club vest 22.00 GBP - 75.00 GBP
Active Seniors (Over 21) - 73.00 GBP
Active Students, Pensioners and Unemployed - 53.00 GBP

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:

Male

Female

Please make a selection.

Events Interested in

Sprint Middle distance Long distance Throws Jumps Hurdles

Please make a selection

Please enter athletes event performance.

Do you have a coach?

Yes

No

Please make a selection.

Would you like coaching?

Yes

No

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?

Yes

No

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 englandathletics.org/myprofile

Yes

No

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?

Yes

None

Please make a selection.

If yes, please state the medical conditions we should know about

Please enter medical condition.

Has the athlete been immunised against tetanus?

Yes

No

Please make a selection.

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Does the athlete use an inhaler?

Yes

No

Please make a selection.

Is the athlete able to use the inhaler without supervision?

Yes

No

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. Full subscription must accompany this application.
3. The completed forms and subscriptions will be sent to the Membership Secretary and stored securely online.
4. You agree to abide by the club code of conduct whenever you are present at club activities or competitions.

I wish to become a member of Woodford Green AC with Essex Ladies.

Please select all to continue

I authorise if the named athlete requires medical treatment, the team manager of Woodford Green A.C. with Essex Ladies, to sign on my behalf any consent form required by a qualified medical practitioner

Please select all to continue

I consent to the named athlete being photographed or videoed.

Please select all to continue

I agree to abide by the club code of conduct whenever I am at club activities or competitions.

Please select all to continue

I am aware of and agree to be bound by UKA Anti-doping rules and I agree to abide by the UKA code of conduct appropriate to my age and role at the club.

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.

Signature

Sign Above

Clear

Please sign here.

 

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