Oxfordshire Federation of Young Farmers’ Clubs
Tel. 07899 727 995 PO Box 246
Email: [email protected] Wantage Website: www.ofyfc.org.uk OX12 2EP
Registered Charity No. 304397 Membership Application Form 2017/18
Name: Membership Fee Due: £ ______Please pay Club Treasurer The details on this form will be held on the County Membership Database and the National Federation of Young Farmers’ database. Please ensure you complete all the required details clearly and complete all the blank white boxes. When you have done so, please return to your Club leader / Treasurer. County Office on receipt will be send your new membership card via your Club Treasurer. Please inform your Club and County of any changes to the following details.
Member- Jun / Int/ Sen / Assoc /Non Bicester & Islip Juniors Membership No. 50 11 _ _ _ ship Type Please circle as applicable
House name
No./Road/Street
Village
Town
County
Post code
2 Emergency contact names, relationship to member & phone nos. 1: Email address provided No access to the 2: For Newsletter + Diary Dates website Please complete the following, so that we are aware of any special requirements: Disabilities and / or behavioural difficulties Medical conditions / medicines (also pto) We have to record your White (including British, Irish, any other white background) ethnic background Mixed (including White & Black Caribbean, White & Black African, White & Asian, any other Mixed background) Please tick box Asian or Asian British (including Indian, Pakistani, Bangladeshi, any other Asian background) Black or Black British (including Caribbean, African, any other Black background) Chinese Other Ethnic Group Do not wish to answer I apply for membership of the Oxfordshire Federation of Young Farmers’ Clubs.
Member’s signature: Date:
Email / don’t email re Weekly News Members under 18 Parent/Guardian signature: + Diary Dates Delete as appropriate In signing this form you are agreeing to allow this member to participate in the activities of this Club and gives responsibility for the supervision of this member to an individual in a position of responsibility. Each club takes responsibility for the safe running of all its events as determined by NFYFC policies. Any falsification of signature will deem the insurance cover and membership void. It is a condition of membership that you also complete the Parental & Medical Consent Form on the reverse of this application.
USE OF YOUR DETAILS – Information provided by you will be held on our database at the County YFC Office and by the National Federation of Young Farmers’ Clubs. Wales FYFC will hold details of members in Wales. If you do not wish your details to remain on our database once your membership of YFC expires on 31st August. Please inform NFYFC that you would like your details removed. NFYFC or County Federations will not pass any information held on their database to any other organisation but details of products and services provided by them for your benefit may be promoted through the normal NFYFC mailing systems. If you do not wish to receive these mailings, please tick this box.
Parental & Medical Consent Form for all Members Under 18
PARENT / GARDIAN – Please complete this additional information Name of Parents/Guardians Mobile or contact Phone No.
School Attended
It will be assumed that a Parent/Guardian will collect the above-named member from the Club unless otherwise stated below: PLEASE DELETE AS APPLICABLE: * I give permission for the above-named member to travel home unaccompanied * I nominate those person(s) named below as authorised to collect in my absence: Name 1: 2: 3: Contact No.
Please ensure that you, or the person collecting, checks out with the Club Leader/Officer before leaving Name of two additional responsible adults who can be contacted in an emergency: Name 1: 2: Contact No. Child’s Doctor: Name Contact No. Address
Additional information required about the member named overleaf: Please give details if “yes” Any allergies e.g. antibiotics, penicillin, elastoplast, aspirin or any such medicines, foods etc? No Yes Detail: Ever suffered from any of the following conditions - Diabetes, asthma, migraine, fits, fainting or anything else? No Yes Detail: Receiving any medical treatment or on any prescribed medication? No Yes Detail: Frequency: Side Effects: Any disabilities and / or behavioural difficulties No Yes Detail: Any other special needs e.g. dietary, wheelchair access? No Yes Detail:
As parent or guardian. please sign the following declarations: I am willing for my son/daughter/young person in my care to attend meetings of the above YFC club, to take part in lawful activities organised at Club or County and to them being transported, if required, by other YFC members/officials. I also understand that the insurance policy is made available to me via the County Office or NFYFC and understand the extent and limitations of the insurance cover provided. I understand that the YFC clubs cannot accept responsibility for the members’ possessions or valuables whilst they are attending the club. Please note, you may be asked to complete additional consent forms if the above-named member goes on any supervised trips or takes part in any YFC activities which do not form part of the normal club or county programme of activities. This includes National events. Signature of Parent/Guardian ………………….…………………...….. Date ……………………….… The above medical information is correct as far as I know. In the event that I cannot be reached in an emergency I hereby give my permission to the physician, selected by the chairman/club leader/club representative acting on behalf of the club, to hospitalise or treat my son/daughter/ young person in my care, including proper anaesthesia, injection or surgery. Please note, it is your responsibility to inform us of any changes to this medical information. Signature of Parent/Guardian ………………………………….……… Date ………………………… Oxfordshire Federation of Young Farmers’ Clubs
Tel. 07899 727 995 PO Box 246
Email: [email protected] Wantage Website: www.ofyfc.org.uk OX12 2EP
Registered Charity No. 304397 Under the Data Protection Act 1988 we need to obtain your consent before photographing your son/daughter/young person in your care. We therefore ask your consent for still photographs to be taken for use within displays, the website or for marketing and advertising purposes, including use for publicity and marketing by NFYFC. In addition, local press may also use photographs of participants in YFC activities on occasions.
I do/do not consent (delete as appropriate) Signature …………………..…..…...... Date ……………..………