Juniors 12-17 Membership Form

Junior Membership (8-11 years)

Child's full name *

Child's date of birth *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Are you currently a member of another running Club? *

Parent / Guardian Details

Parent / Guardian name *

Parent / Guardian phone number *

Parent / Guardian email address *

Health Declaration and Participation Statement

Does your child have any specific medical condition or disability?

Medical consent *

I understand that this information will be shared with my child’s coaches to enable them to provide a safe training environment. Confidentiality will be maintained.

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 (parent / guardian) 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 child’s 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.