Apply

URN

Section A: Athlete's Details

First Name

Last Name

Number & Street

Town

Post Code

Phone Number

Email Address

Birth Date

Country of Birth

Gender at birth

MaleFemale

What kind of membership do you want?

Full Member with EA affiliation (preferred)Full Member No EA Affiliation (cannot enter races as an Elswick Harrier)

Social Member (non-running)

Status

EmployedUnwaged

RetiredFull Time Education

Have you already been a for a club night run?

Section B: Parent / Carer Details

Parent/Carer First Name

Parent/Carer Last Name

Parent/Carer Phone No.

Section C: Additional Support

Please detail any disability or additional support you may require from the club coaches

Section D: Medical Information (do not leave blank)

See help text for guidance ->

Section E: Emercency Contacts

Emergency Contact 1 - Full Name

Emergency Contact 1 Phone

Emergency Contact 2 - Full Name

Emergency Contact 2 Phone

Section F: Welfare / Photography / Video Consent )for those under 18).

Are there any welfare or safeguarding issues in relation to the applicant?

Yes - issuesNo issues

I agree to photos and video of me / my child (ren) being used appropriately by the club

YesNo

TO BE COMPLETED BY PARENT/CARER OF APPLICANT UNDER 18.

Please select one of the below “I agree” statements.

I agree & understand my responsibility to collect my child (ren) at the end of a club training session.I agree & confirm that I am happy for my child (ren) to leave the ACTIVITY after it is finished and make their way to be collected.

I agree & confirm that I am happy for my child (ren) to wait in the SPECIFIC WAITING AREA (AS DESIGNATED) AFTER THE activity has ended.

SECTION G: Club privacy statement and communication preferences

Elswick Harriers take the protection of the data that we hold about you as a member seriously and will do everything possible to ensure that data is collected, stored, processed, maintained, cleansed and retained in accordance with current and future UK data protection legislation. Please read the full privacy notice carefully to see how The Club will treat the personal information that you provide to us. We will take reasonable care to keep your information secure and to prevent any unauthorised access. See all club policies here.

Accept privacy and other policies

Agree

SECTION H: Data transfer to England Athletics

When you become a member of or renew your membership with Elswick Harriers you can also choose to be registered as a member of England Athletics (you will have to register with England Athletics if you ever compete for the club in competition Under UKA Rules). If you tick the box below 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 contact dataprotection@englandathletics.org

I want to join England Athletics now. Tick box below:

Join England Athletics

SECTION I: Athlete / Parent Agreement

By returning this completed form, I confirm that the information I have submitted is accurate and that I have read and understood the privacy statement and how data will be used and shared. I agree to provide written notice in the event of my (or my child’s) intention to terminate membership of the Club.

Name as signature

Date of agreement

Only fill in if you are not human

Elswick Harriers

Location

Affiliations

Juniors: Age 10 – 17

Seniors: Age 18 Plus