MEMBER/ATHLETE PERSONAL DETAILSFirst Name* Last Name* Address Line 1* Address Line 2 City* Region* Postcode* County* Date of Birth* Place of Birth* Gender* Male Female Name of School/College* Emergency Contact Name* Emergency Contact Number* PARENT OR GUARDIAN IF APPLICANT IS UNDER 18 YEARS OLDFirst Name Last Name Phone Mobile Email IF APPLICANT IS OVER 18 YEARS OLDMobile Email COLLECTION FROM TRAININGIf completing for a Child under 16yrs old, is the child allowed to make their own way home?* Yes No Not Applicable If being collected please specify the name of the individuals who are permitted to collect your child other than yourself First Last First Last First Last MEDICAL INFORMATIONDoes the member suffer from any illnesses which would prevent them from either training or competing and which should be brought to the attention of the Club.* Yes No If Yes please explainDoes the member have any special requirements of which the Club should be aware.* Yes No If Yes please explainDo you use an inhaler or preparation?* Yes No Do you have any of the following disabilities* No disability Speech Impairment Restricted Mobility Mental health survivor Visual impairment Hearing Impairment Amputee Wheelchair User Cerebral Palsy (Brain Trauma) Dwarfism Learning Disability Other (Please provide details below)EQUAL OPPORTUNITIESBe Fit Today has a strict policy of equal opportunities and anti-racism, aimed at treating everyone fairly irrespective of race, colour or national origin. Please tick the relevant box below to indicate the group to which you belong. Information you provide will be treated in the strictest confidence and is used for statistical monitoring.Ethnic Category White English / Welsh / Scottish / Northern Irish / British Irish Gypsy or Irish Traveller White and Black Caribbean White and Black African White and Asian Indian Pakistani Bangladeshi Chinese African Caribbean Arab Other Ethnic Category (Please specify)Faith Category Christian Muslim Sikh Jewish Hindu Buddhist Other Faith Category (Please specify)Personal DataWhen you become a member of or renew your membership with Be Fit Today Track Academy AC you can also choose to be registered as a member of England Athletics (we will have to register you with England Athletics if you ever compete for the club in competition Under UKA Rules). If you tick the box below Be Fit Today Track Academy will provide England Athletics with your personal data, which they will use to enable access to an online portal for us to manage (called myAthletics). England Athletics will contact you to invite you to sign into and update your MyAthletics portal (which, amongst other things, allows you to set and amend your privacy settings). If you have any questions about the continuing privacy of your personal data when it is shared with England Athletics, please contact dataprotection@englandathletics.org. In order to compete with Be Fit Today registration with England Athletics is compulsory The above information is only kept on file for monitoring and/or emergency purposes. Your details are not distributed to third parties. You will be added to a newsletter which you can unsubscribe from should you no longer wish to receive this. I understand and agree to my personal data being shared with England Athletics as stated above.* Accept I declare that I am an amateur as defined by UK Athletics laws. I will abide by, the Rules of UK Athletics and the IAAF. I understand that the first year’s subscription will be required to complete my membership application. Membership is continuous and can only be terminated by a written resignation. I understand that photographs in which I feature or written word about me may be posted on the club website, social media sites, and in the local press with reference to competitions that I have competed in for the club, unless I have given prior notification in writing to the website officer and / or club secretary that it is against my wishes to be included in such. I confirm I agree to the athlete’s conduct requirements (which can be found on the BFFTA website) I will notify BFFTA (admin@befittoday.co.uk) of any changes to the above information given e.g. medical conditions, address, contact details etc. I have/will in the future notify BFFTA if l suffer from illnesses which would prevent me from either training or competing and which should be brought to the attention of the Club. I have/will in the future notify BFFTA of any special requirements of which the Club should be aware. Please note the BFTTA reserve the right to cancel of change the dates and times of anyof it activities, sessions or courses. We will endeavour to inform you of these changes at the earlies opportunities By Submitting this form and paying the membership l have read and understood and in total agreement with all the above. I also confirm that the information l have provided is correct to best of my knowledge.* I Accept
