Tri East Development Squad Application

Membership type *

Full Membership £70 per annum Affiliate Membership £20 per annum

Athlete Information

Athlete's Name *

First Name Middle Name Last Name

Birth Date *

Month Day Year

Gender *

Male Female Other

Current School Year *

Address *

Street Address
Street Address Line 2
Town	County
Postcode	Country

Triathlon Club

Swimming Club

200m Freestyle PB

Running Club

1500m PB

Cycling Club

Do you race competitively in the East Region Junior Race Series? *

Yes No

East Region Junior Race Series League Position For Previous Season? *

1st 2nd 3rd 4th 5th

Have you raced at a national event in the last 12 months? *

Yes No

If yes, please state which race and finishing position

Have you previously been selected for the East Region IRC team? *

Yes No

Have you previously attended trials for the East Region triathlon academy? *

Yes No

If yes, please state the points achieved at academy trial

Are you currently a British Triathlon Member? *

Yes No

Parent/Guardian Information

Mother

First Name Last Name

Mobile Number

Area Code Phone Number

Father

First Name Last Name

Mobile Number

Area Code Phone Number

Address (If different from athlete)

Street Address
Street Address Line 2
Town	County
Postcode	Country

Home Number *

Area Code Phone Number

E-mail *

Emergency Information

Emergency Contact's Name *

First Name Last Name

Relationship *

Mobile Number *

Area Code Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Photo Consent

I hereby give consent for photos and videos to be taken of my child whilst participating in Tri East training sessions and whilst racing as part of Tri East. I consent to these photos and videos being used to promote and celebrate the achievements of the Tri East. Please note images may be used on the Tri East website, social media platforms and publications. They may also be used by sponsors or partners to support or promote Tri East, or any event being run by Tri East.

Video/Photo consent given *

Yes No

Parental/Guardian Consent for Participating in Coaching Sessions

I, being the parent/guardian of the child identified on this application, have read the following notes and give consent for my child to take part in the coaching sessions. I understand and agree that my child participates in coaching sessions under the instruction of British Triathlon coaches entirely at his/her own risk and without liability whatsoever on the part of the club, it’s coaches or members. I have considered the nature of such sessions and have discussed them with my child. I am satisfied that they are sufficiently responsible and competent to assume full and entire responsibility for their own safety under the supervision of a British Triathlon coach.

Notes:

· Coaches will take all reasonable precautions to ensure that accidents do not happen, however they cannot be held responsible for any loss, damage or injury suffered whilst your child is participating in training sessions.
· Any member who persistently misbehaves or puts others in danger will be asked to leave the session and may not be allowed to attend in the future.
· Parent(s)/guardian(s) are welcome to stay and watch the sessions but must remain in the designated spectator areas, if available.
· Parent(s)/guardian(s) should respect the coaching timetable by:
o arriving in good time so that a prompt start to the session is possible; and
o arriving promptly to collect your child at the finish time.
If your child is continually late, they may be excluded from future sessions.
· Your child is expected to remain in training sessions from beginning to end, unless they have to leave early.
· If your child has to leave early or is being collected by someone other than the parent/guardian, the parent/guardian must advise the coach of the details of the arrangement, including who will be collecting your child.
· Your child must wear the appropriate kit for all training sessions, have a road worthy bike and must wear a cycle helmet at all times during any cycling activities or whilst riding their bike. If a coach deems that your child is not wearing appropriate kit, or that their equipment is not safe, then they will not be allowed to take part in a session.
· In the event of injury or illness to your child, along with taking all reasonable steps to contact the parent/guardian, the club will deal with that injury/illness by administering any necessary treatment.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Tri East and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.