Athletics Camp 2022 Application Form Step 1 of 5 20% Bicester AC Athletics Camp Application FormFor more information about our camp go to: https://www.bicesterac.co.uk/bac-athletics-holiday-camps/ Section A: Applicants Details.I would like to apply for*Easter Camp (11th - 13th April)Summer Camp (15th - 19th August)Easter Options*Monday 11th & Tuesday 12th (£50)Tuesday 12th & Wednesday 13th (£50)Monday 11th to Wednesday 13th (£70)Summer Camp Options*Monday 15th to Wednesday 17th (£75)Wednesday 17th to Friday 19th (£75)Full Week 15th to 19th (£100)Attendees Full Name* First Middle Last Is the attendee curently a member of Bicester AC*YesNoAddress* Street Address Address Line 2 City County Post Code Date of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What is the Attendees gender?* Current school year*345678910111213University / OtherN/ACurrent School* Section B Parent / Carers DetailsSection B Parent / Carers Details (only if athlete is under 16yrs of age)Parent / Carer. I am a:*ParentCarerParent / Carer full name:* First Last Parent / Carers Address:* Street Address Address Line 2 City County Postcode Parent / Carers Telephone Number:*Parent / Carers Mobile Number:*Parent / Carers Email Address:* Section C: Medical Information.Details:*Please give details of any important medical information (e.g. epilepsy, asthma, diabetes, allergies, etc.) or any additional needs (e.g. disability, learning challenges, behavioural challenges, etc.) that our coaches / young leaders should be aware of. Will the attendee be bringing any medication (e.g. hay fever, asthma, etc.) - if there is no information please put 'None'.Section D: Emergency Contact Details.Emergency Contact One Full Name:* Full Name Relationship to Applicant Emergency Contact One Phone Number:*Emergency Contact Two Full Name:* Full Name Relationship to Applicant Emergency Contact Two Phone Number:*Medical Treatment Authorisation:* Yes Please tick yes to give your consent to emergency treatment being given to the named applicant on this form by trained personnel, as it may be essential at some time for authorised persons acting on behalf of Bicester AC to have necessary authority to obtain urgent treatment which may be required whilst at the summer camp.Authoriser's Name* First Last Date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Section E: Attendee's Agreement.Agreement:* Yes By selecting Yes I agree to abide by: 1: the athlete codes of conduct. The clubs code of conduct can be found here www.bicesterac.co.uk/bac-club-information/codes-of-conduct/. 2: I agree that the club officials may take & publish photos (print / internet) of me for club promotional purposes. ( subject to the clubs safeguarding / photo policy which can be found here http://www.bicesterac.co.uk/bac-club-information/). 3. The camp rules which will be set out in the confirmation. 4. The Covid policy set out in the Summer Camp Codes of Conduct – Polices – Legal. 5. Data provide in this form will be stored and used in-line with Bicester AC's data protection policy.Applicant's Name:* First Last Agreement Date:*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Section F: Parent / Carer Agreement:Agreement*Please select appropriate. By selecting Yes I agree : 1. To the named attendee taking part in the activities of the summer camp. 2. I agree that the club officials may take & publish photos (print / internet) of me / my child for club promotional purposes. (subject to the clubs safeguarding / photo policy which can be found here http://www.bicesterac.co.uk/bac-club-information/). If you do not want the attendee to be photographed and used inline with the clubs policy, please notify the club. 3. Data provide in this form will be stored and used in-line with Bicester AC's data protection policy.YesParent / Carer's Name:* First Last Agreement Date:*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Captcha* I am not a Robot. 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