MEMBERSHIP / RENEWAL FORM

SECTION A: ATHLETE DETAILS

Preferred Events RoadCross CountryFell & HillTrail

SECTION B: MEMBERSHIP

Type of Member: Active RunnerNon-active RunnerLife Member

Renewal or New Member RenewalNew Member

1st Claim or 2nd Claim 1st Claim2nd Claim

NEW MEMBER - FIRST TIME MEMBERSHIP INCLUDES CLUB COLOURS VEST or T-SHIRT (email: stevetebb@hotmail.co.uk) —Please choose an option—1st Claim - in paid employment £391st Claim - not in paid employment £351st Claim - Junior (15 to 17)* £352nd Claim - in paid employment £262nd Claim - not in paid employment £21Social Member (no vest) £7 RENEWAL —Please choose an option—1st Claim - in paid employment £201st Claim - not in paid employment £161st Claim - Junior (15 to 17)* £162nd Claim - in paid employment £152nd Claim - not in paid employment £1.50Social Member (no vest) £7 *Juniors of Adult Section not Junior Section

SECTION C: PARENT/CARER DETAILS (aged under 18s only)

If you are under 18 years of age, please ask your parent/carer to complete the following section:

Please Note: This is a required field, so England Athletics can invite you to access your MyAthletics portal to complete the registration process with them. England Athletics will not market to you without your express consent.

SECTION D: ADDITIONAL SUPPORT

SECTION E: MEDICAL INFORMATION

I consent to my special category personal data provided in section D and E to be shared with coaches for the purposes of delivery of my safe participation in club activity. This data will not be shared or
processed for any other purpose.YesNo

SECTION F: EMERGENCY CONTACT DETAILS

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

SECTION G: PHOTOGRAPHY & VIDEO CONSENT (aged under 18s only)

Clowne Road Runners recognises the need to ensure the welfare and safety of all young people in athletics. In accordance with the UK Athletics child protection policy and procedures, we will not permit photographs, video or other images of children/young people to be taken without the consent of the parents/carers and children/young people. The Club will take all possible steps to ensure these images are used solely for the purpose they are intended. If you become aware that these images are being used inappropriately you should inform the Club immediately. I (parent/carer) consent to (Clowne Road Runners or a photographer appointed by the Club) photographing or videoing my child’s involvement in athletics for the period shown in this form for the purpose of publicising and promoting the club or sport, or as a coaching aid.

SECTION H: CLUB PRIVACY STATEMENT & COMMUNICATION PREFERENCES

Clowne Road Runners (The Club) take the protection of data that we hold about you as a member seriously and will do everything possible to ensure that data is collected, stored, processed, maintained, cleansed and retained in accordance with current and future UK data protection legislation.

Please read the full privacy notice carefully to see how The Club will treat the personal information that you provide to us.
We will take reasonable care to keep information secure and to prevent any unauthorised access.

Opt In
Please tick if you would like to receive general Club information via the email you provided.Please tick if you would like to receive messages via WhatsApp.

SECTION I: DATA SHARING WITH ENGLAND ATHLETICS

When you become a member of or renew your membership with Clowne Road Runners, you will automatically be registered as a member of England Athletics. We will provide England Athletics with your personal data which they will use to enable access to an online portal for you (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). It is vital a valid email address is given, so that you can ensure that your data is correct and so that you can set your own 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.

SECTION J: ATHLETE AGREEMENT

By submitting this completed form, I confirm that I have read and understood the privacy statement and how data will be used and shared and am willing to abide by the club code of conduct for athletes.

Δ