Adult Membership Form

Adult Membership

First Name *

Last Name *

Date of Birth *

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Are you currently a member of another running Club? *

Emergency contact details

Emergency contact name *

Emergency contact number *

Relationship to you *

Health Declaration and Participation Statement

Health Declaration *

Tick the box to confirm you have read this information.

In line with guidance from Scottish Athletics, we ask all participants to review the following before taking part in any club activity.

Health Screening (PAR-Q)

You should consider the following questions before participating:

Has a doctor ever advised that you have a heart condition or that you should only exercise under medical supervision?
Do you experience chest pain during physical activity?
In the past month, have you experienced chest pain when not exercising?
Do you suffer from dizziness, light headedness, or loss of balance during exercise?
Do you have any bone, joint, or musculoskeletal issues that could be aggravated by running?
Are you taking any medication that may impact your ability to exercise safely?
Are you pregnant or post-partum?
Do you know of any other reason why you should not take part in exercise?

If you answer “yes” to any of the above, you are strongly advised to seek medical advice before participating in club activities.

Participation and Responsibility

By attending any session organised by Strathaven Striders, you acknowledge and agree that:

You have read, understood, and considered the health information above.

You are responsible for your own health and fitness to participate.

You will inform a run leader of any relevant health concerns where appropriate, or of any relevant change in your circumstances.

You will run within your own abilities and follow instructions given by run leaders.

You understand that participation in running activities carries inherent risks, including the risk of injury or illness and by participating you waive any legal recourse for personal injury or damages arising from your participation.

Implied Consent

Attendance at any club session constitutes your acceptance of this declaration and your consent to participate in club activities.

Confirmations

Amateur *

I confirm that I am an amateur athlete.

Personal information *I agree that Strathaven Striders may publish my personal Information as part of the results of any event and may pass such information to the governing body or any affiliated organisation for the purpose of insurance, licences or for publishing results either for the event alone or combined with, or compared to, other events. Results may include (but not be limited to) name, any club affiliation, race times and age categoryYesNo

Contact *I agree that the Club may contact me from time to time with information about training, events and information related to my membership and participation. YesNo

Media *I agree that Strathaven Striders may use my image on the Club Website, Social Media Platforms or for the purposes of promoting the Club, it’s training and events. This includes photograph and video images.YesNo

Please do not fill in this field.