SCOTTISH UNDER 23 CHAMPIONSHIPS ENTRY FORM

TEAM CAVANAGH WLC

CALEDONIA HEALTH & FITNESS CENTRE

358 NETHERTON ROAD, ANNIESLAND, GLASGOW

G13-1AX

SATURDAY 16th May 2015

Weigh-In - 9 am – 10 am. Start 11am

Please complete this form fully and in BLOCK CAPITALS

Name
Address
Post Code:
Date of Birth / Gender Male/Female
Contact Phone No. / E-mail
CLUB / WLS Membership No.
Total Achieved
Current Age / Years: Months:
Please Circle Bodyweight Class you intend to compete in below.
MALE / FEMALE
56 / 62 / 69 / 77 / 85 / 94 / 105 / 105+ / 48 / 53 / 58 / 63 / 69 / 75 / 75+

l You should note that the closing date for entries is the Sat 2nd May 2015

l Your WLS Membership Card must be shown at the weigh-in. Photographic I.D. or Birth Certificate to be shown at the Weigh-In. No WLS Membership card or proof of I.D. then you will not take part in the competition.

l Competitors will be notified of any changes to the above details, e.g. weigh in time, change of day or reducing a day depending on competitor numbers.

l With this entry form you must enclose the following:

Entry Fees – £15.00 (by Sat 2nd May 2015) -

Entries sent to – Ray Cavanagh, 12 Ashgill Road, Parkhouse, Glasgow, G22-6QH

Cheques payable to Team Cavanagh Weightlifting Club

All lifters must enclose a Parental Consent Form.

No entries will be accepted after the deadline date of Sat 2nd May 2015.

I agree to be bound by the rules and regulation of WLS and declare that I am physically fit to undertake the sport of weightlifting and have no knowledge of any medical condition which will make weightlifting contra-indicated to my well being.

Signed ______Date ______

Conditions of Entry to the Scottish Under 23 Championships Sat 16th May 2015

1)  There are no Qualifying Totals for these Championships.

2)  That your entry is received by Sat 2nd May 2015 with the entry fee of £15.00

3)  That, if you are taking any medication whatsoever you have checked whether it is prohibited or not prohibited on the UK Anti Doping Organisation (UKADO) Drug Information Database Shortcut to: http://www.globaldro.com/uk-en/default.aspx. For advice, contact .

WEIGHTLIFTING SCOTLAND (WLS)

UNDER 18 PARENTAL CONSENT AGREEMENT FORM

ANTI DOPING AND DISCIPLINARY REGULATIONS

I ______(name) of ______

______(address)

Confirm that I have parental / guardian authority for

______(athlete’s name)

I confirm that:

(1)  I give permission for my son / daughter to compete in the Scottish Under 23 Championships on Saturday 16th May 2015 and confirm that he / she is physically fit to undertake the sport of weightlifting.

(2)  I consent and agree to my son / daughter complying with anti doping testing, and being bound by all the provisions of the Anti-Doping Rules, and any determinations made in accordance with BWL/WLS Anti-Doping Rules.

I understand that a refusal to provide consent may affect the athlete’s involvement in WLS/BWL events and activities and WLS may refuse to allow the athlete to participate in such events.

(3)  My son / daughter is taking / not taking* a prescribed medication by our doctor or pharmacist (delete where appropriate)

If your child is taking any medication then contact the immediately for advice. Medication for asthma may be prohibited by the International Olympic Committee and World Anti Doping Agency, but the BWL can help you apply for an exemption.

(4)  I consent to photographing and videoing of my child in the weightlifting competition under the stated rules of the WLS/BWL Child Protection Policy.

Signed ______

Date ______

Data Protection Act 1984: Information supplied on this form may be held on computer.