Please state whether you have any specific disabilities and/or give details of any important medical information that we should be aware of (e.g. epilepsy, asthma, diabetes, allergies etc.). If none, please tick the box, do not leave blank.
Please provide names and phone numbers of TWO people who should be contacted in the event of an incident/accident.
It may be essential at some time for authorised persons acting on behalf of the Club to have the necessary authority to obtain urgent treatment which may be required while at representative club competition or training. Please tick below to give your consent to emergency treatment being given to the named athlete on this form by trained personnel.
Like most athletics clubs, we rely on volunteers to run our weekly training sessions, put on events such as track and cross country meetings and to generally manage club affairs. Just a few hours per year would be a real help to us.
Ealing Southall & Middlesex AC is committed to ensuring the welfare and safety of all young people involved in athletics. In line with UK Athletics child protection policies and procedures, the Club will take all reasonable steps to ensure that any photographs, videos, or other images of children and young people are used appropriately — solely for the purposes of promoting the club, publicising the sport, or as a coaching aid. If you become aware of any misuse of such images, please contact the Club Welfare Officer immediately.
Ealing Southall & Middlesex AC takes the protection of the 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 your information secure and to prevent any unauthorised access.
When you become a member of or renew your membership with Ealing Southall & Middlesex AC 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, therefore, that 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.
By submitting this completed form, I confirm that I have read and understood the Privacy Notice, and how data will be used and shared, and am willing to abide by the club code of conduct for athletes and parents.
