The North Uist AAC has a healthy membership base of over 100 athletes.  This is drawn from the islands of North Uist, Berneray and Grimsay.  The form below can be printed out, completed and handed in at any club night.

North Uist Amateur Athletics Club

Registration & Consent Form For People With Parental Responsibility 2006-2007

CHILD'S DETAILS:

Surname:_____________________________ First Name(s):___________________________    

D.O.B.:_____________________Address:______________________________________________

________________________________________________________________________________

_____________________

Contact Telephone

nos:___________(daytime)___________(evenings)______________(mobile)Additional Telephone

nos:________________________________________________________

SCOTTISH ATHLETICS NUMBER(if applicable):________________________________________

MEDICAL INFORMATION:___________________________________________________________________

________________________________________________________________________________

_______________________________________________________________

Any other relevant information (e.g. medical, dietary or sleeping requirements):

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

_______________

Doctor's Name:__________________________________Telephone no:__________________

My child is in good health and I consider him/her capable of taking part in athletics. I consent that, in the event of any illness/accident, any necessary treatment can be administered to my child, which may include the use of anaesthetics which are necessary in the opinion of a medically qualified practitioner. I also understand that, whilst Club/Team personnel will take every precaution to ensure that accidents do not happen, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child.

I also do/do not give my permission for my child to be photographed by a committee member or pre approved photographer for the purpose of displays, the club's website, publicity shots and as evidence of what the club achieves. The club will not disclose the names of any children featured in any publicity shots without the prior permission of the parent/guardian.

PERSON WITH PARENTAL RESPONSIBILITY

Name: _________________________________________________(Please Print)

Signature:___________________________________________________________________

Date:____________________

A yearly membership fee of £15.00 is applicable for one child & £25.00 per family, cheques made payable to: NUAAC