365 Application - Team Bath Athletic Club

Child's First Name

Child's Last Name

E-mail *

Address Line 1 *

Address Line 2

Address Line 3

Town *

Postcode *

Home Phone

Mobile Phone

Date of Birth

Gender *

Male
Female

Nationality *

Required for UK Athletics Registration

Medical & Emergency Information

Medical

Please give details of any relevant medical conditions that officials/coaches of the club should be aware of

Emergency Contact *

In case we need to contact someone when you are training with us. Please include at least one name and phone number.

Photographic Permission *

I give permission for photographs including the child named above to be used in publicity material
I DO NOT give permission for photographs including the child named above to be used in publicity material

TBAC would like to use topical photographs for publicity and the website. Please indicate if you would be happy for photographs in which your child features to be used for this purpose.

Parent or Guardian *

First

Last

Confirmation by Parent/Guardian *

I confirm the details above are correct

Medical & Emergency Information

Email General Enquiries

Email Editor Bath Plug – TBAC’s Weekly Magazine

Sports Training Village

Affiliated Club