BRACKNELL GYMNASTICS CLUB
                                              MEMBERSHIP FORM (Sept 2010 - Aug 2011)

                                To be completed annually for all members (gymnasts & coaches).

Name                                                                     Date of Birth


Postcode                                                  Home Tel.

Mobile                                                    Email

Demographic info

Please disclose any information that the coaches should be made aware of, whether it is medical, behavioural or

Emergency Contact 1
Name                                                                        Relationship
                                                                            to gymnast

Home Tel.                                                                   Mobile

Emergency Contact 2
Name                                                                        Relationship
                                                                            to gymnast

Home Tel.                                                                   Mobile

Volunteer disclosure

Clubs may have limited funds, but their expertise is only limited by the wiliness of members and supporters to offer
their services on occasions. If there are expertise or resources that you might be willing to offer regularly / on
occasions / in an emergency, then please give us details below.

             British Gymnastics Affiliation: 69981        Registered Charity: 1130234      Registered Company: 6910301

Statement                                                                                   Agree / Disagree          Signature
                                                                                            (Tick or Cross)

The club can make good use of video cameras to analyse skills and give valuable
feedback to the gymnasts. If you agree for videoing to be used in this way, please sign.

The club may wish to take still photos of gymnasts with medals/certificates and take
action shots from video footage to publicise the club and the gymnasts’ achievements in
local press and on the club’s website. If you agree for photography to be used in this
way, please sign.

I have seen and accept the club’s governing document and agree to abide by polices and
the codes of conduct for participants / coaches / parents / spectators. Parents sign on
behalf of the gymnast if under 18 (and their spouse/other legal guardian to a minor),
however, they must ensure that their child and any other legal guardian is aware of the
codes of conduct with which they must abide. All current polices can be found at

Signed: _____________________________ Print Name: _______________________________
(Parent signs for gymnast if under 18)                              Date: ____________________________________
Paying Fees

The chart below details the fees required for Club and British Gymnastics (BG) affiliations. Please pay either by cheque or bank transfer.
Cheques for your club fee, plus the appropriate BG fee should be made payable to Bracknell Gymnastics Club on one cheque.
Bank Transfers should be to: Account Name: Bracknell Gymnastics Club; Bank: Lloyds TSB Bracknell; Sort Code: 309111;
Account No: 03552401. Please email to give notice that the payment has been made.
 Tick                                                                        CLUB FEES

          Club fee            £11*       To be paid by all gymnasts being training and competing for Bracknell Gym Club. *£10 if paying by bank
                                         transfer. £7.50 for each additional member from the same family & home address.

          Gift Aid         Bracknell Gymnastics Club can reclaim basic rate tax (currently 20%) from HM Revenue & Customs on all gifts, provided you
                           have paid an amount of UK income or capital gains tax equal to the tax we reclaim. This means that your club subscription
                           increase in worth by 28% at no cost to you. If you pay tax at the higher rate, then you can claim further tax relief on your self-
                           assessment tax return.
                           I wish Bracknell Gymnastics Club to treat the sum of _______________________ (club subscription) as a Gift Aid declaration.
                           Signature: _________________________________Print Name: _________________________ Date: ____________________

 Tick                                              BRITISH GYMNASTICS AFFILIATION FEES (please tick one)

          Bronze Membership                  £15          Welfare Officer / Secretary / Helper Grade / Club or County Judge / Recreational Gymnast (i.e.
                                                          not competitive).

          Silver Membership                  £40          Level 1 Coach / Competitive Gymnasts / Regional Judge

          Gold Membership                  £72.50         Level 2-5 Coaches / National or Brevet Judge

          Joint Gold Membership         £58.50 (each)     Gold Members who share the same address

          Linked member                      Nil          All those who pay the appropriate affiliate via another BG club. Please state:
                                                          Club_______________ BG No. __________________Level of Membership________

This membership form should be sent to Mr D Crann, Director of Finance, 3 Tawfield, Bracknell, Berkshire RG12 8YU
along with the cheque if you wish to pay this way.

           British Gymnastics Affiliation: 69981                      Registered Charity: 1130234                      Registered Company: 6910301

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