(Senior members, please complete the senior membership form.)
Legal Full Name:
Likes to be known as:
Date of Birth:
Gender: —Please choose an option—femalemale
A First Claim member is one who is eligible to compete for the club in all competitions. An athlete may only belong to one club as first claim.
If your child is already a member of another athletics club, he/she you can join Poole Runners as a Second Claim member. Second claim members may only compete for Poole Runners events that their ‘first claim’ club are not competing in.
First Claim MemberSecond Claim Member
If you are joining Poole Runners as a Second Claim member, then please provide the name of the First Claim club here:
If you wish to transfer your child’s ‘first claim’ from one club to another there is a special form and procedure which must be adhered to under UKA rules. Please speak to a coach or other officer of the club if this is the case.
The club relies entirely on the services of volunteers. Don’t worry if you can’t commit to offering any help, but if you think you might be able to help support the club by volunteering for events, or are willing to be contacted when your help may be needed, please indicate this below.
I would like to actively volunteer, feel free to contact me when events are coming upI would like to volunteer but I think I will only be available sometimes, let me know if you’re short of volunteersI can’t commit to volunteering, please don’t ask, I will let you know when I can support events.
Any children attending events will be looked after to the same standards, whether volunteering or competing.
I am happy for my child to volunteer for events if they cannot compete
Relationship to athlete:
In the event of an emergency, who should we contact?
Please list your child’s medical conditions that the coaches or officers of the Club need to know about, including any medication currently being taken or must be relied upon in an emergency, or if there are any known allergies.
If you have concerns about confidentiality or need to provide further details, please discuss these with your child’s coach.
Surgery Contact Number:
In registering your child with the club, they may also be registered with England Athletics.
It is a requirement of England Athletics that if you are or will be 11 years or over during this membership period and you want to compete in any EA registered event you must pay the EA registration fee each year.
You will be issued with an individual registration number by the EA. Most of the events or leagues that Poole Runners take part in would require you to be EA registered. If you do not want your child to compete in any EA registered event either as a member of the Poole Runners Team or individually you do not have to pay the £15.00 fee.
Poole Runners Membership: Full Year (1st April 17 – 31st March 18): £20 or Half Year (1st Nov 17 – 31st March 18): £10
England Athletics: £15 per season.
Track Fees: These can be paid in advance via standing order (£10 per month), or at training (£2.00 for each session).
Account for standing order (NOTE: This is different to the account for fee payment): Sort Code: 40-13–07, Account Number: 21837133, Account Name: Poole Runners, Reference: Athletes name (ie: Mo Farrah)
Select Membership Type:
Member + English AthleticsMember only
Select Track Fees Payment:
Pay At TrainingPay Via Standing Order
Via Bacs - Bank Account No: 21837125, Sort Code: 40-13-07, Account Name: Poole Runners, Reference: Athletes name
Via Online - Credit Card Using The Poole Running Events Website
Via Cheque - Made Payable To Poole Runners
The club and its officers are bound by the regulations of the Data Protection Act 1998. The information you have provided in this form will be treated confidentially and will not be disclosed to any unauthorised persons.
When you become a member of or renew your membership with Poole Runners you can also choose to be registered as a member of England Athletics (you will have to be registered with England Athletics if you ever compete for the club). If you are EA registered we will provide England Athletics with your personal data, which they will use to enable access to an online portal for you (called myAthletics). England Athletics will contact you to invite you to sign into and update your MyAthletics portal (which, amongst other things, allows you to set and amend your privacy settings). If you have any questions about the continuing privacy of your personal data when it is shared with England Athletics, please contact firstname.lastname@example.org.
Access to an athlete’s information will also be made available to coaches and authorised officers of Poole Runners solely to facilitate club activities. Examples of this may include, but are not limited to:
o Race entry
o Club member demographic survey
o Parent Contact for the purposes of discussing Poole Runners activities or in an emergency
Please read and accept the following statements by ticking the acceptance box at the bottom of the form. If you have any concerns or need to highlight any conditions that you must attach to these statements, please make them known before, or at the time that you submit this form.
1. Data protection, information management and confidentiality.
I understand and accept how the information provided on this form will be managed and that if there are any changes, I will make the club aware by writing to Matt East or Joanna Brodie and briefing club-coaches as soon as possible.
My child is in good health and can take part in athletics training and events.
In the event my child needs FIRST AID or EMERGENCY MEDICAL/DENTAL TREATMENT when participating in events and training activities as a member of POOLE RUNNERS, any officer of the club or other adult acting on behalf of the activity, is authorised to ensure that appropriate medical or dental treatment is provided for my child, to protect their health and wellbeing.
Where the potential treatment requires intervention by healthcare professionals, I will be contacted using all reasonable methods, specifically using the contact details provided with this form; if I cannot be contacted, my authorisation extends to all necessary medical intervention including the prescription of any medication/anaesthetic necessary for the treatment of my child, if so deemed by an authorised healthcare professional and not previously contra-indicated.
Any changes to my child’s medical status or the scope of this authorisation will be immediately communicated to the club.
I understand that Club or Team personnel will take every reasonable precaution to prevent accidents from happening and that belongings are cared for. While club staff are conducting themselves within the stated scope of their role for the club I will not hold them liable for any loss or damage to equipment, or injury to my child.
4. The Use of Photography and Film
I am aware of and am satisfied with the club’s policy regarding child protection particularly that “Photographs, videos, or other images of young people will not be taken without the consent of the parent or guardian of the child”.
I, therefore consent to Poole Runners using photographic or video footage of my child’s involvement in athletics.
Once taken, the Club will take all reasonable steps to ensure that any images are used solely for reasons that support the promotion of the club, its events and activities only, including promotional material for club events where permission is given and within closed groups on Facebook.
If I become aware that images are being used outside of this remit, or I withdraw my permission for my child’s images to be used in this way, I will communicate this to the club.
5. Anti-Bullying Policy
Poole Runners are committed to providing a caring, friendly and safe environment for all our members so they can participate in a relaxed and secure atmosphere. Bullying of any kind is unacceptable at our club. If bullying does occur, all athletes or parents should be able to tell and know that incidents will be dealt with promptly and effectively. We are a TELLING club. Please acknowledge by signing below that anyone who knows that bullying is happening is expected to tell the club welfare officer or any committee member; by signing you are also indicating that if you have any concerns about bullying but don’t feel you can have the opportunity to raise them in person, then email details of your concerns to the address above and the U18 Chairman and Secretary will address your concerns in the strictest confidence.
6. Adherence to Poole Runners & UKA Code of Conduct and Rules
I acknowledge and agree with the club’s ethos of fair play and inclusion for all its members. I agree that a good standard of behaviour is expected always, from all members and their families, when attending events or training supported by the club. The club has published rules and adheres to the UKA code of conduct which applies to athletes, parents and coaches. I agree that my child will abide by these rules.
 The Club rules are available at http://www.poolerunners.com or from the club secretary
 The UKA Code of conduct is available from http://www.britishathletics.org.uk/governance/welfare-and-safeguarding/guidance-documents-and-policy, coaches, or at the athletics track.
I have read & agree with the declaration 1-6 above.