WEYMOUTH ST PAUL’S HARRIERS & AC
MEMBERSHIP APPLICATION FORM 2025/2026
| Treasurer: | Gareth Manning |
| Membership Secretary: | Tracy Moore |
AFFILIATED TO UK ATHLETICS
Membership is restricted to those aged 8 years and over.
All memberships are accepted at the discretion of the
Committee.
This membership information is stored on paper and will only be
used for club purposes. It can be shared with England Athletics
FOR OFFICIAL USE ONLY
| MEMBERSHIP NO. | |
| DATE OF ELECTION | |
| FEE PAID |
Mr/Mrs/Ms/Miss/Other: Mrs
First Names: Cathy
Surname: Collins
Full Postal Address: hunters moon, watery lane,weymouth, DorsetPost Code: DT3 5QD
Telephone No: 07447560131
Telephone No Alternative:
Email Address: cathy.collins2015@outlook.com
Date Of Birth: 21/09/1972
OTHER ATHLETICS CLUB: If you are joining as a second claim member please give the name of your first claim club:
MEMBERSHIP FEES
NOTE: 2025/2026 Membership fees INCLUDE the EA Registration Fee (in some case)
Road running - All ages (to include EA) £28
Total To Pay £40.00
PLEASE NOTE: Memberships are due on the 1st APRIL each year .We reserve the right to add a late payment levy to anyone not renewing their membership by 30th APRIL
All members of Weymouth St Paul's Harriers and Athletics Club must abide by the Club Codes of Conduct. These are available to view on the website.
- Code of Conduct for Athletes
- Code of Conduct for Parent/Carers
- Social Media/GDPR Policy
SIGNATURES
APPLICANTS:
I HEREBY DECLARE:
1. That I am an Amateur according to the UK Athletics Rule 1, eligibility to compete.
2. That I will abide by the UK Athletics Laws and Regulations for Competitors.
3. That I will show courtesy to all officials, coaches and other athletes.
4. That I will observe Club rules.
5. That I will pay the weekly training fees on time (juniors).
6. That I consent for qualified first aiders or a qualified physiotherapist to treat minor injuries.
7. That the above particulars are complete and correct.
8. Any IMPORTANT MEDICAL FACTS have been noted on an attached sheet.
I have read and understand the club codes of conduct.
Signature of Applicant Cathy Collins
Date Signed 26/02/2026
PARENTS/CARERS:
Parental Consent (for members under 18)
- I will ensure that my child adheres to the club rules.
- That I give permission for photos to be taken of my child and for the photos to be used :
I have read and understand the club codes of conduct.
Signature of Parent/Carer (For Members U16)
Date Signed
EA Registration
All athletes from the age of 10 years MUST register with England Athletics if they intend to compete.
From 1 April 2026 the Registration Fee will be £23
WSPH & AC will administer the registration on your behalf, and subsidies the cost.
(Juniors pay £33 for club membership and EA registration)
Name Cathy Collins
Age Group 2026/2027Masters(35+)
I confirm that I will be a competing athlete during the 2026/27 summer & winter period 1 April-31 March.
I have paid my full membership to the club and please would you register me with England Athletics.
Signed Cathy Collins
This may be the parent signature of athletes under 18 years)
EA Number4145387
Data Shared with EAyes
Medical Form 2026/2027
This form is required, as part of our commitment as a club to provide a safe environment for both athlete/helpers to ensure parents/carers are contacted should an accident or sudden illness require urgent medical attention. Please inform us of any changes to contacts or if medical circumstances change.
Athletes nameCathy Collins
Date of Birth21/09/1972
Parent/Carer/Next of Kin's NamePeter Shuttleworth
Parent/Carer/Next of Kin's Contact Numbers HOME07966215252
Parent/Carer/Next of Kin's Contact Numbers MOBILE07966215252
Doctors Surgery and Surgery Telephone NumberCliff Villages Surgery TEL: 01522811411
Does your Child/Do you – suffer from any Medical conditions/disabilities/allergies?yes
List of medical conditions/disabilities/allergies and treatment receivedAllergic to penicillin and coeliac
(You must be registered with U.K.A if taking medication for Asthma and you are a competing athlete)
In an extreme emergency do you agree for an approved First Aider/Coach to administer First Aid?
Please Tick for agreementyes
Signed Parent/Carer/Adult MemberCathy Collins