APPLICATION FOR MEMBERSHIP TO WALTON A.C. – 2008/09
Welcome to Walton Athletic Club and we hope you enjoy training and competing with us.
Walton AC was established in 1942, and despite its long and successful history, has continued to be a small and friendly club where individuals are valued for their effort and achievement. The club has over 200 members ranging in age from 9 years up to 60 years and over, and participates in a number of different leagues to provide competition for all age-groups over 11 years.
More details about the club can be found at our web site at
Aims of the Club
To promote athletics (in Elmbridge and nearby communities)
by providing training and competition through the Club structure;
by encouraging more people to join the Club.
Walton Athletic Club is committed to an Equity Policy for athletics. The club aims to ensure that all people, irrespective of age, gender, disability, race, ethnic origin, creed, colour or sexual orientation have a genuine and equal opportunity to participate in athletics at all levels and in all roles. That is as a participant, coach, administrator or official.
Training Times
Training takes place at Stompond Lane on Tuesday and Thursday evening and on Sunday mornings, at different times according to age and ability.
Junior9 - 12 yrs approxSunday09.45 – 11.00 hrs
Coaches Terry Letheby (01932-860656)
Wendy Letheby(01932-860656)
General12 - 15 yrs approxTuesday18.30 - 20.00 hrs Sunday 10.30 - 12.00 hrs
CoachesAlan Lewiston(01932-854063) Ian Howell(020-8941-7572)
Rod Parker(01932-222510) Ros Aylett(01932-848401)
John Lane(01932-245700) Mike Fraser(01932-229606)
Guy Sellwood(020-8941-6743)
Debbie Singleton(01932-225351)
Special Squads 14/15yrs plusTuesday18.30 - 20.30 hrs
and SeniorsThursday18.30 - 20.30 hrs
Sunday10.30 - 13.30 hrs
CoachesAndrew Kennard (0208-893-1254)
Jon Hamblen (01252-513145)
Jack Rutherford (01932-225351)
Pat Amos (01784-241673)
Membership Fees
Fees for new members (which includes a free club vest) are as follows for the 2008-2009 season (1st March to 28th February). Ages are as of 31st August 2008.
JuniorUnder 11 years£50.00
General11 - 17 years / students£75.00 (includes free club vest, see Mem Sec.for details)
Senior Men and Women£85.00 (includes free club vest, see Mem Sec.for details)
Associate (X country, Track only etc.)£25.00
Please can you complete the membership form and return it with the appropriate membership fee to:-
Acting Membership Secretary at 21 Dale Road Walton-on-Thames, Surrey, KT12 2PY (01932-225351)
or give it to any of the Club Coaches. Cheques should be made payable to ‘Walton Athletic Club’.
WALTON ATHLETIC CLUB
THE SPORTS GROUND
STOMPOND LANE, WALTON-ON-THAMES, SURREY KT12 1HF
MEM No.______
APPLICATION FOR MEMBERSHIP TO WALTON A.C. – 2008/09
Please complete in Block Capitals
Full Name ...... …………...... Male Female
Address...... …………......
...... …………………………………..……......
Post Code...... ……………………………………………………………………………………….
Telephone No...... …Mobile…..……………………………………………..
E-Mail...... ……………………………………………………………...... …………
Membership Type……………………………………….Date of Birth.…………………………………………..
Please detail any important medical information that the club should be aware of, if none state none.
……………………………………………………………………………………………………………………..
Do you consider yourself to have a disability? Yes No If Yes, what is the nature of your disability?
………………………………………………......
In order for the club to monitor its membership please tick one of the following boxes to identify your ethnic group
White…………. Mixed…….….. Asian….…… Black…….…… Chinese…….……
Other Ethnic Group (please State)…………………………………………………………………………………
Have you perticipated in athletics before…Yes No If Yes, at what level: (please indicate below)
Primary School. Secondary School Local Authority coaching session Club County
Other (please specify) …………………………………………………………………………………………
I agree to abide by the Rules and Regulations of the Club, details of which can be found at
I give my consent to allowing the above information to be entered on the Club's computer data files and that this information can be distributed within the club membership for use in running the clubs activities.
I also declare that I take part in all club activities at my own risk and understand that Walton A.C. will not be held responsible for any loss or injury to my person or property as a result of those activities.
Unless otherwise stated I agree to promotional photographs being placed on the club web site or notice board.
EMERGENCY CONTACT DETAILS – TO BE COMPLETED BY PARENT/GUARDIAN IF ATHLETE IS UNDER 18 YEARS
Contact name (e.g. parent/guardian) ………………………………………………………………………………
Emergency contact Number ……………………………………………………………………………………….
I agree to my son/daughter/child in my care taking part in the activities of the club.
I understand that in the event of any injury or illness all reasonable steps will be taken to contact me and to deal with that injury/illness appropriately.
Signature of Candidate...... Date...... …………
Signature of Parent / Guardian (if under 18 years of age)...... …………
Amount Paid..£………………………………………….Cheque/Cash……………………………………………
Cheques should be made payable to ‘Walton Athletic Club’