Junior Membership Form Please enable JavaScript in your browser to complete this form.SIDMOUTH RUNNING CLUB Junior and Family Membership Form 2020 Family Membership is defined as a maximum of 2 adults plus children under the age of 18.Membership Categories and Subscription Rates *Individual £15Family £40Member 1 - Name *FirstLastMember 1 - Gender *MaleFemaleMember 1 - Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Member 2 - NameFirstLastMember 2 - GenderMaleFemaleMember 2 - Date of BirthMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Member 3 - NameFirstLastMember 3 - GenderMaleFemaleMember 3 - Date of BirthMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Member 4 - NameFirstLastMember 4 - GenderMaleFemaleMember 4 - Date of BirthMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address and Post Code *Telephone Number *Email *Emergency phone number *Emergency contact name *The Constitution, Rules, Safeguarding and GDPR Privacy Policy can be found on the websiteCertificate of Authority by parent or guardianI/We agree to be bound by the Constitution and the Rules of the Club and those of England Athletics.I hereby certify that the above details are correct and that I give full consent for the above applicant to become a member of the club and to participate in training and competitions within the sport of athletics.Signature of Parent or Guardian *Date *Medical Information. Please supply any relevant medical information, medications, special needs or allegies.Do you give permission for photography/videos of your child on social media, the club website or in the press? *YesNoDo you give permission for photography/videos which would be used for training purposes only? *YesNoTick if you do NOT give permission for any photography or videos.I do not give permission for any photography or videos.Complete this online form and pay by bank transfer with the member's name in the reference section. Please complete the online form and do the bank transfer at the same time.Payment method *Pay by Bank Transfer - ensure your name goes in reference box - Sort code: 40 42 02, A/C 61493078WebsiteSubmit
