Summer Camp Application Form | Bicester Athletic Club

Summer Camp 2021 Application Form

Step 1 of 5

Bicester AC 2021 Summer Camp Application Form
Section A: Applicants Details.
I would like to apply for*
Member's Full Name*
First Middle Last
What is the Applicants gender?*
Address*
Street Address Address Line 2 City County Post Code
Date of birth*
Current school year*
Current School*

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Section B Parent / Carers Details
Section B Parent / Carers Details (only if athlete is under 16yrs of age)
Parent / Carer. I am a:*
Parent / 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:*

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Section C: Medical Information.
Details:*
Please give details of any important medical information that our coaches / young leaders should be aware of (e.g. epilepsy, asthma, diabetes, allergies, 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 representative club competition or training.
Authoriser's Name*
First Last
Date*

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Section E: Applicant's Agreement.
Agreement:*
- Yes
By selecting Yes I agree to abide by: 1: the codes of conduct relevant to my position within Bicester AC and agree to always behave in a manner befitting a Bicester AC member when attending training and club events. 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. 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:*
Section F: Parent / Carer Agreement:
Agreement*
Please select appropriate. By selecting Yes I agree : 1. To the named athlete taking part in the activities of the club. 2. That I have read and agree to abide by the club code of conduct whenever I am present at club activities or competition, code of conducts can be found here www.bicesterac.co.uk/bac-club-information/codes-of-conduct/. 3. To helping at club events. 4. 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/). 5. Data provide in this form will be stored and used in-line with Bicester AC's data protection policy.
Parent / Carer's Name:*
First Last
Agreement Date:*

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Captcha*
- I am not a Robot.

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Step 1 of 5

Bicester AC 2021 Summer Camp Application Form

Section A: Applicants Details.

Section B Parent / Carers Details

Section C: Medical Information.

Section D: Emergency Contact Details.

Section E: Applicant's Agreement.

Section F: Parent / Carer Agreement:

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