Membership Application Form 2007/08

Oxfordshire Federation of Young Farmers’ Clubs

Tel: 01869 232 231 County Office

Email: 4 Cheshire Dr

Website: Upper Hetford

Oxon

Registered Charity No. 304397 OX25 5TQ

Membership Application Form 2012/13

Name: Membership Fee Due: £______Please pay Club Treasurer

The details on this form will be held on the County Membership Database. Please ensure you complete all the required details clearly and complete all the blank white boxes. When you have done so, please post back to County Office at the address above. On receipt, you will be sent your new membership card via your Club Treasurer. Please inform your Club and County of any changes to the following details.

Faringdon Juniors / Membership No. / 50 / 08 / _ _ _ / Member-ship Type / Jun / Int/ Sen / Assoc /Non Please circle as applicable
Title
Middle name initials
Preferred name
Date of birth
Home phone no.
Work phone no.
Member’s Mobile phone no.
Email - important
House name
No./Road/Street
Village
Town
County
Post code
2 Emergency contact names, relationship to member & phone nos.
1:
2:
Weekly News, Oxfordshire Young Farmers’ newsletter is added to our website and notification sent by email. Please tick the appropriate box opposite. Hard copy distribution limited to those who do not have access to the website. Please ensure your email address is CLEARLY WRITTEN ABOVE!
Email address provided
For Newsletter + Diary Dates / No access to the 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. By signing this application, I agree to their code of conduct, “Who Cares”, a copy of which I received with this form and have read.

Member’s signature: / Date:
Members under 18 / Parent/Guardian signature: / Email / don’t email re Weekly News + 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 a database at the County YFC office and the National Federation of Young Farmers’ Clubs. NFYFC 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 system. If you do not wish to receive these mailings, please tick this box 

If you do not wish your details to remain on our database once your membership of yfc expires, 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 …………………………

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 ……………..………

County Coordinator – Jo Arnold