Hoddesdon Tri- Club
Affiliated to British Triathlon Federation
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Hoddesdon Tri- Club Affiliated to British Triathlon Federation
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Hoddesdon Tri Club Junior Membership Application Form. 1st January to 31st December 2011 Surname: __________________________ First name: ___________________________ Sex: M / F Address: ________________________________________________________________________ Town: _________________________County:_________________ Postcode:__________________ Parent’s Name: ____________________________ Contact Phone: (h) __________________ (w) ___________________ (Mob) _________________ Alternative Emergency Contact name: ____________________ and Number: __________________ Email Address: ______________________________________ School/College: __________________ Date of Birth: ________________________ B.T.F. Number: ____________________ Would you describe yourself as having a disability? _______________________________________ I hereby acknowledge that triathlon and duathlon can be dangerous and physically very demanding sports and that I participate in them at my own risk. Neither the Club nor the Committee will be held responsible for accidents that occur while I participate in these sports. I understand that the Club has adopted the BTF code of practice for Child Protection. The Club recommends that members should consult their doctor before participating in club training sessions or competitions. Any relevant medical condition must be notified below. During coached sessions, I accept responsibility for notifying the coach on each occasion. Relevant Medical Conditions.____________________________________________________________________ I apply for membership of the Hoddesdon Tri Club and agree to abide by the Club rules which are available on request and will be posted on the Club website. I am aware of the Hoddesdon Tri Club policy on Photographic & Video Images of Children/Young People under the age of 18yrs and consent to photographs of me/my child being used as described in it. I understand that my child has to wear an approved cycle helmet to all club sessions involving bikes Signed: _______________________________________Date:____________________________ Signature of Parent /Guardian: _____________________________________________________ Please send this form, together with your Membership Fee to Bruce Crowther, 29, Oak Grove, off Mangrove Road, Hertford, Herts, SG?? ??? or hand in to Bruce or Sally at a training session. 2011 Fee Structure (Membership runs until 31 December 2011) Membership Fee: ￡25 per annum. Session Fees: Paid monthly by Standing Order (Swimming): ￡ Paid monthly by Standing Order (Land Training): ￡ Paid each session (Swimming): ￡5-00 Paid each session (Land Training): ￡3 OFFICIAL USE: Fee Received:_____________________Membership Number:_____________________
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