Juvenile Membership Renewal - Brothers Pearse A.C.

New Members ONLY

Please note that your application for membership needs to be confirmed by a member of the Juvenile Committee before submitting this form or transferring funds.

When completing the form please note:

One form is needed for each Athlete;
Remember to put your name/your child's name on the Bank Transfer.

New or Existing Member *Existing MemberNew Member

Male / Female *MaleFemale

Athletes Name *Email Address *Birth Date *

Address

Street Address Line 1 *Street Address Line 2Street Address Line 3Eir Code *

Parents Details

Parent Name *

Parent Contact Number *

Home Phone Number

Parent Name 2 *Parent Contact Number 2 *County of Birth *Are there any medical conditions the club should be aware of? *

This includes asthma, allergies, diabetes or difficulty in concentration. Please supply details, including details of medication your child may need at training (eg asthma inhaler, insulin)

Bank Account Details

Membership Fees:

1st Child - €120
Any subsequent child - additional €90 each
Family Membership - €275

93-32-95-01275094

BIC: AIBKIE2D

IBAN: IE14AIBK93329501275094

Please specify which Payment Method you have used: *

We would really appreciate if you could pay subs into our Bank Account. This is safer and makes it so much easier for us to manage. Again, please remember to put your name/your child's name on the Bank Transfer.

I Paid into Bank Account as AboveI am unable to pay into Bank Account but will pay by Cash/Cheque on Registration Night

Confirm Date when Payment to Bank Account was Made *

Parents/Guardian Consent Form

Please complete the following as your child will not be allowed to train unless a completed form is returned to the club.

Do you give permission for your child to partake in athletics and train with Brothers Pearse Athletic Club? *

YesNo

Do you give permission for your child to leave training unaccompanied by an adult at the end of training? *

YesNo

Do you give permission for photographs of your child to be used on the Bros Pearse website? *

YesNo

Do you give permission for your child to receive necessary first aid? *

YesNo

Do you agree to your child taking part in competitions for the club? *

YesNo

I understand that it is my responsibility to ensure training is on when I drop off my child and to collect her/him promptly. *

YesNo

All Athletes must abide by the following:

Respect and listen to your coach and abide by the rules during all coaching sessions and at competitions.
Compete for Bros Pearse Athletic Club at events organised by Dublin Athletic County Board
Do athletics because you, the athlete, want to do it.
Commit to attending regular training sessions
Never bully another athlete. Treat other athletes as you would like to be treated.
Do not behave in a way that could cause injury to other athletes.
Refrain from use of bad language and offensive gestures.
Never cheat at competition or at training.
Make an effort to improve yourself.
Contact your coach/club if you are not available for training or competition.
Never make false allegations about another athlete or adult.
Never chew chewing gum at training.
Talk to children’s officer or designated officer if you have any concerns.
Never keep secrets about someone who has caused you harm.
Above all enjoy your sport and make it enjoyable for those around you.

I Confirm that I have brought these rules to the attention of The Athlete:Full Name *

Well Done!

Your submission has been received!

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Juvenile Membership Renewal 2020

New Members ONLY

Address

Parents Details

Bank Account Details

Membership Fees:

Parents/Guardian Consent Form

All Athletes must abide by the following:

Well Done!