Online Registration

Please note our Privacy Notice (agreement), which is referred to in the registration form, can be located here.

Participant's First Name*

Participant's Middle Names

Participant's Last Name*

Gender*

Date of Birth*

Street Address 1*

Street Address 2

Town*

County*

Postcode*

Name of Parent/Guardian (if under the age of 16)

Email*

Emergency Contact Details

Name of Emergency Contact 1*

Relationship to Participant*

Phone Number for Emergency Contact 1*

Name of Emergency Contact 2*

Relationship to Participant*

Phone Number of Emergency Contact 2*

Name and Address of GP Surgery*

Please use the following section to provide any medical conditions that might impact the health and performance of the above-named, participating in judo;

Details of current medical conditions such as asthma, difficulties with hearing, Asperger's, ADHD, ASD, epilepsy etc. that might affect how your child trains or that might be effected by training in judo.
Details of any known allergies e.g. penicillin, nuts and whether or not emergency medication is carried for such allergies.
Details of medicines, teaching methods or support that may help your child's training.

(If there is no medical information relevant, please write none applicable (n/a) or none known)

Medical Information*

Medical Consent*

I take responsibility to ensure that my child/ I have the correct medication or support with them/ myself when training in the club or attending events outside the Club

Consent (Parent/Guardian if under the age of 16)

Please Tick all the elements you agree with below:

Consent*

I agree that the above named may take part in activities organised by Carmarthen Judo Club. I understand that while involved, he/she will be under the supervision and care of the judo coach and/or other adults approved by the British Judo Association and that, while the staff in charge of the group will take all reasonable care of the child/adult they cannot be held responsible for any loss, damage or injury suffered by the child/adult during, or as a result of, the activity.

I understand that Judo is a contact sport.

I understand that I can withdraw my consent at any time and will inform the club immediately to make changes to the registration information.

I have read the club's Privacy Notice and understand there are copies to be found on the club's noticeboard and website.

I agree to inform the club immediately of any changes to the information provided.

Carmarthen Judo Club may take photos/ videos for Judo related promotion and Judo related achievements - for example, competition results, grading promotions etc. These may be used in the local newspaper, Club website, Social media or Club noticeboard. Please select which option best applies;

Photography Consent

Photography Consent*

Record futher details below: