Waitakere City Athletic Club: Registration Form - West Auckland Track & Field, Cross Crountry, Coaching

Registration Form

To become a member of the Waitakere City Athletic Club, please fill in the registration form below.

If you'd prefer to send in a printed form, you can download the Registration Form PDF here>>

Club Fees
Club fees are due at the start of the Athletics year 1 April 2009 to 31 March 2010. Fees for the year are as follows:

Age/Birth year (This does not reflect age grade)	Club Fee	Athletics NZ & Auckland Reg. Fee	Total Fee 2008/2009 Season
Masters 60+ (1948-earlier)	$36.00	$59.00	$95.00
Senior & Masters 60- (1949 -1988)	$36.00	$74.00	$110.00
Under 20 years (1989-1993)	$36.00	$59.00	$95.00
Under 15 years (1994)	$36.00	$34.00	$70.00
Under 14 years (1995-2001)	$36.00	$29.00	$65.00
Under 7 years (2002- later)	$20.00	n/a	$20.00

Please note: A club singlet must be used and can be purchased from the club for $40.00. Some secondhand singlets may be available. No fees will be refunded 2 weeks after payment.

First Name: *
Last Name: *
Street Address: *
Suburb: *
City: *
Email:
Birth Date: *	Please use the format DD/MM/YYYY (for example 01/12/1980)
Gender: *	Male Female
Phone (Home): *
Phone (Work):
Phone (Mobile):
Parent/Caregivers Name: (if under 18 years old)
Have you previously belonged to the Waitakere City Athletic Club? *	Yes No If not, please provide a photocopy of athlete's birth certificate
Do you have a current singlet? *	Yes No
If no, you will need to purchase a singlet for $40, please provide your size:

Club Night Roster (during the summer season only)
There is a huge amount of effort that goes into organising the club nights, therefore, the assistance of parent/caregivers on a roster basis is compulsory. It's a fun evening and a great way of watching your children and meeting others.

I will assist: *	Most Nights On a Roster Basis All Nights
I prefer to assist in the following areas:	Grade Manager Time Keeper High Jump Long Jump Discus Shot Put

Total Fee Payable

*

Athletics Auckland & Athletics NZ Fee Explanation
These fees are the portion of all registered athletes fees that go towards the overall administration of Athletics and Athletics New Zealand and this levy assists in the funding of our sport at a Regional and National level. To compete in Athletics Auckland Centre events or in any event as a "Registered Athlete" these fees must be paid.

Payment Methods

Please select your payment method:*

By Post (cheques only)
Direct Credit
In Person (cash or cheque)

Cheque
Please make cheques payable to: Waitakere City Athletic Club Inc.
and post to Waitakere City Athletic Club Inc., Po Box 21084, Waitakere 0650.

Direct Credit
Account details: 03-0187-0342413-00.
Please use athlete's name as the reference.

In Person
You may pay your club membership by cash or cheque at your first club night.

Athlete number will be issued once payment is confirmed.

Privacy Act
I consent to the information supplied on this form being incorporated into the club's register and for it to be available to club members to contact each other on athletic club related matters. I also consent for photos showing myself taken during athletic events to be displayed on the club website. I may request for a photo to be removed by contacting the club.

Medical
The club accepts no responsibility for any injury suffered whilst (1) taking part in any club activity or (2) being on grounds or premises controlled by the club. Members and/or Parent/Caregivers give the club permission to seek medical attention if any sickness or injury occurs while at the club.

Are there any medical conditions pertaining to the athlete that the club should be aware of? *	No Yes
If yes, please specify:
Do you wish to be emailed on:	General club information General athletics Junior athletics Senior athletics Harriers

*	Declaration Yes, I declare that I am an amateur as defined by I.A.A.F. rules. I agree to abide by the rules of the I.A.A.F. and intend to compete at my own risk.

* required fields