Parc Bryn Bach Running Club Membership Application Form

We are pleased to welcome you to Parc Bryn Bach Running Club.


Personal Details




MaleFemale






Existing Club

Are you currently registered with another Running Club?

YesNo

If yes, name of Running Club currently registered with


Disability

The Disability Discrimination Act 1995 defines a disabled person as anyone with 'a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities'.

Do you consider yourself to have a disability (please tick)?

YesNo

If yes, what is the nature of your disability?

Visual impairmentHearing impairmentPhysical disabilityLearning disabilityMultiple disability


Medical Information

Please detail below any important medical information (e.g. epilepsy, asthma, diabetes, etc).

NB. At each and every training session and activity arranged by the Club, it is solely the runners responsibility to notify the group leaders of any medical condition that they have that could arise during such activities. Ultimately, all runners participate in club training sessions and activities entirely at their own risk.

If you have any reason to doubt whether your general health and fitness is suitable to running, you should seek medical advice before joining and participating. The nominated Officers of Parc Bryn Bach Running Club do not offer any professional medical or other professional advice.


Emergency Contact Details

Please insert the information below to indicate the person(s) who should be contacted in the event of an incident/accident.

Contact 1



Contact 2




Membership Fees

Parc Bryn Bach Running Club Welsh Athletics
£15.00 £17.50

Declaration

I confirm that the details provided are correct and it is my responsibility to notify Parc Bryn Bach Running Club of any changes.

I also confirm that I fully accept and understand that any activity I participate in, arranged by Parc Bryn Bach Running Club, I do so entirely at my own risk.

I Confirm


By submitting this form electronically I am confirming my Declaration above.


Upon submission the Club Membership Secretary/Treasurer will contact you to arrange payment for your membership.

The information you provide using this form will only be used as part of membership process and will not be published on the website.