Membership

Become a Member

LEICESTESR CORITANIAN ATHLETIC CLUB

Please complete the form below and read the application notes further below and retain for reference.

Your details

First name

Last name

Email

Phone

Birthday

Day

Month

Year

Place of birth

If under 18 name of parent/guardian

Name of School or College (if aplicable)

Your address

Multi-line address

Country/Region

Address

City

Zip / Postal code

Membership option

1 Year subscription choice

Senior (18yrs and over) - £55

11 - 17 years + full time students - £50

Under 11 years - £20

Associate member - £20

Family membership - see notes below

Have you resided at your present address for at least 9 months?

Yes

No

If not, when did you move to the Midland Counties AA area?

Please provide in dd/mm/yyyy format

Have you previously been a member of an athletics club?

Yes

No

If Yes, please name your previous club and if applying for 1st claim give date of resignation

Medical declaration

This information is strictly confidential. Please also provide your coach and team manager with your medical details. Should your medical details change please advise your coach and team manager accordingly.

Your emergency contact's name

Your emergency contact's number

Please list any medical conditions below

If you carry any medication, please state if so and what below

Do you have any allergies? If so please state below

Please provide details of any emergency procedures (e.g epipen, inhalers, insulin etc)

Social media

Do you (parent/guardian) consent to images of you/young person to be used for social media and club publications?

I consent

I do not consent

Ethnic information

We would be grateful if you would provide the following information. This will be used for equal opportunities monitoring and/or will help us understand how we might provide you with appropriate help and support. The information will be kept secure and confidential in accordance with the Data Protection Act.

Gender

Male

Female

Your age

Terms & conditions

I agree to abide by the laws of the sport as set down by UK Athletics, MCAA, L&RAA and any other relevant bodies. In particular I acknowledge that taking of banned substances and other practices prohibited by UK Athletics and other governing bodies, in or out of competition, is an offence and that to be eligible to participate in athletic competitions I must make myself available for testing when required – Rule 24, April 2000

I have read and agree to the notes listed on this page.

I hereby confirm that I also agree to the England Athletics code of conduct (please refer to EA members portal).

Signature

Signature field is empty.

Application For Club Membership Notes

Please print & retain a copy

Subscriptions are due annually on 1st January. In order to compete for Leicester Coritanian in club or championship competitions athletes must be current, fully paid up, members.
Membership of Leicester Coritanian A.C. includes membership of England Athletics which in turn makes an athlete eligible as an individual or a team member for championships or other events. It also carries entitlement to any relevant insurance cover arranged by UK Athletics.
Subscription fees only allow athletes to compete for Leicester Coritanian. Athletes are responsible for payment of any fees levied by sports centres or other such venues to allow them to train or compete.
Family membership fees for competing athletes: 15% reduction of full cost for 3+ children.
Athletes are responsible for purchasing their own clothing and club vests. Club vests are to be worn when representing Leicester Coritanian AC in club competitions or championships. Please contact a team manager or the club treasurer (see below) for advice on purchasing club vests. Vests can be purchased by post, from the Treasurer, post and packaging will apply.
Unless provided by the sports centre or other such venue, athletes are responsible for providing their own equipment for competitions or training (starting blocks, javelin, shot etc.).
Athletes are expected to compete when selected.
Team selection is the responsibility of the relevant team manager, whose decision is final. Team managers may consult coaches and other club officials to assist them in selecting a team.
Athletes and parents will be expected to abide by the decisions of the team manager on the day of competition and are therefore not expected to try to influence the team manager’s decisions.
Any queries regarding team selection or any other matters of concern should be made, in writing, to the club secretary.
Athletics can be dangerous. Athletes must NOT enter the track or any throwing or jumping areas unless instructed to do so by the team manager or other official.
Athletes must act responsibly and remain vigilant at all times particular when participating in throwing events.
All members attending club or championship meetings must respect all other people attending these events. This includes other athletes, club officials, meeting officials, team managers etc.
Parents and other helpers will be expected to assist, when required, at club events.
Failure to comply with the above could result in your membership not being renewed.
This information will be kept secure and confidential in accordance with the Data Protection Act

All payments should be made payable to Leicester Coritanian Athletic Club

BACS:

Account Number:60532789

Sort Code:40-28-06

Membership will not be processed without payment. Please provide athlete name as reference.

Become a Member

Arrange a free taster session with us

Our club is open to anyone passionate about athletics, from young talents to adults, who are serious about developing their skills and competing at the highest levels.

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