Membership Form 2007

 

Name:                                                                                      Nickname:                                           

 

Age:                                                   DoB:                                                              M / F

 

Address:                                                                                                                              

 

                                                                                                                                               

 

Parent Contact:                                                                                                                 

 

Phone Number:                                                                                                                 

 

e-mail:                                                                                                                                  

 

School:                                                                                                                                

 

PE Teacher:                                                                                                                        

 

Favourite Athletic Events (please circle):

 

Running (sprints)                   Running (Middle Distance)              Cross Country

 

Long/Triple Jump                  High Jump                                          Sports Hall Athletics

 

Javelin                                    Discus                                                Shot

 

Hammer                                 Pole Vault                                          Multi-events

 

Walking                                  Fell Running                                       Triathlon

 

Other Sports Played

 

 

 

 

 

 

 

Normal Weekly Activities Timetable (eg, PE lesson, swimming club, dancing, etc):

SUN

MON

TUE

WED

THU

FRI

SAT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Health conditions (eg, asthma, etc):

 

 

 

 

 

 

 


Are you registered disabled?                                                                                        

 

Ambitions in Athletics (eg, fitness, fun, County standard, Olympics):

 

 

 

 

 

 

 

 

 

Personal Bests / Proudest Achievements:

 

 

 

 

 

 

 

 

 

 

Cultural / Lifestyle Details (eg, religious beliefs, diet, dress code, etc):

 

 

 

 

 

 

 

 

 

Signed:                                                                                 Date:                                     

 

Parent:                                                                     

 

 

 

Parental Photograph Consent

 

We are asking your permission to take and use photographs for the purpose of updating the Junior’s applications and want to cover everybody in reports when they are racing. Some photos could be used for different websites such as BOFRA, FRA and K&CAC.

 

 

I give permission for photographs of  ……………………………………………………………….

to be used mainly for the K&CAC website.

 

Signed:  …………….……………………………………     Date:  ……………………………………..