Consent

Name 1 (Adult)
Name 1*
FIRST NAME LAST NAME
Date of birth 1
Name 2 (Adult)
Name 2
FIRST NAME LAST NAME
Date of birth 2
Name 3 (Juvenile)
Name 3
FIRST NAME LAST NAME
Date of birth 3
Name 4 (Juvenile)
Name 4
FIRST NAME LAST NAME
Date of birth 4
Name 5 (Juvenile)
Name 5
FIRST NAME LAST NAME
Date of birth 5
Name 6 (Juvenile)
Name 6
FIRST NAME LAST NAME
Date of birth 6
CONTACT DETAILS
Phone*
Email*
Do you wish to receive text message and/or WhatsApp updates
- YES, I wish to receive text messages and/or WhatsApp updates
Medical Conditions (Voluntary)
Are you a new member to Glenmore A.C. in 2019?*
- Yes
- No
If you answered Yes above:
How did you hear about our Club? Would you like a Committee Member to contact you to tell you about upcoming Club activities and events?
CONSENT
Declaration*
I give permission for photographic images to be taken of my child/children to be used for promotional purposes solely and exclusively by Glenmore A.C.

I agree to abide by the rules and regulations of Glenmore A.C. and the rules for using the track facilities at Bush - all displayed on club website: Please see Rules & Regulations

I as a registered competing athlete, training with Glenmore A.C. will commit to compete in the Louth Champtionships and local race meetings.

I will respect my teammates and mentors.
- I consent to the above

Name 1 (Adult)