Registration Form

Personal Details

Please complete the personal details of the person requesting this program booking.

Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

DOB*

Home Telephone No.

Mobile No.

Email

Emergency Contact

Please provide details of the person you wish to be contacted in the event of an accident or emergency.

Emergency Contact Name

Relationship

Mobile No.

Doctor Surgery

Please state any medical conditions we should be aware of?

Do you take any medication with you when running, if so where is it kept?

Do you suffer from any of the following?

Asthma
Diabetes
Heart Problems
High Blood Pressure
Joint Problems
Back Pain
Previous Injuries

ASTHMA: Please ensure you carry your inhaler if you have one.

*

I understand that my medical history is shared with the Chair and Membership Secretary. If they feel that my medical history should be shared with the Leader of the Group I am in they will inform me first

Running Experience & Goals

Providing us with details of your running experience and goals will help us ensure that the correct training is provided for you.

Would you class yourself as

A begineer
Can run 5k
Can run between 5k and 10k
Can run 10 miles or more

When was the last time you ran and how far?

What are your exercise experiences (current/previous)

What are your goals or reasons for participating in running?

Club Ethos

To help all people of Swansea to learn to run for life, believe in yourself and to compete with you and only you. We believe running is the best form of excerise to keep you physically and mentally fit. We believe everyone can run and we can help you achieve your personal goals. Our club is a non-for profit organisation. Any surplus income is donated to the Paul Popham Fund, Renal Support Wales.

Club Fees

All sessions are free, unless we use facilities where there is a cost – at this point we ask members to pay a nominal fee to cover the costs of facilities such as Track. There is an annual membership of £40 once you have completed either your first 8 or 9 week program as a beginner runner or competed 3 sessions as a non-beginner.

Communication

Please confirm the best form of communicating updates from the club:

Facebook
Email
Text
Please tick to confirm you are happy to receive updates on the running club
Please tick to confirm you are happy to receive updates on the charity Paul Popham Fund, Renal Support Wales

Declaration*

Running group leaders are qualified leaders in the welsh Athletics Coaching Certificate and are willing to share their experience and enjoyment of the sport with me. I can confirm that I am 16 years of age and I understand that my participation in this group is entirely at my own risk and should consult my doctor if suffering from any condition that make running injurious to my health. I am aware that I must feel well prior to each session and will notify the leaders should I feel unwell at any time during the session. I understand that my participation and safety are my responsibility. I understand that the information on this form will be stored on the Paul Popham Running Club database and will be shared only with the Chair and Membership Secretary unless you have specified any medical condition that you are happy for us to share with your group leader. I understand that being part of the club photo’s and videos maybe taken and shared on the clubs social media site, website and with external media for purposes of publicity.

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PPRC Registration Form

Personal Details

Emergency Contact

Running Experience & Goals

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