Application for an Elite Card

Elite Card Criteria

1.  To qualify applicants must be participating at the following level:

2.  All applicants must be residents of the district.

3.  Applications must include one reference from the applicants coach. This may be in the following forms.

Please note a second reference may be requested.

4.  Elite cards are given as a yearly fixed term membership with a charge of £10 per annum. This must be paid before an application will be processed.

5.  The application form must be posted to Elite Card, St Albans Sport and Health Team, St Albans District Council Offices, St Peters Street, St Albans, AL1 3JE.

Elite Card Terms and Conditions

The card allows free access to gym, swim and group exercise classes only across the District at council owned facilities, subject to availability. Court and pitch hire is not included.

Inductions may be required at Leisure Centres before Elite Card holders can use the facilities.

Access to individuals sports and group exercises will be limited to availability, occur a charge and in some instances may not be offered within the facilities.

Access to the individual sports may also be limited where the equipment used may jeopardize the individual’s safety and that of others.

The card cannot be used to gain free or discounted access to sports specific courses or make block bookings/ court space under the individuals name free of charge.

The card must be used by the name holder only.

The card does not permit external personnel or your coach access. All sites have level 3 personal trainers who are happy to support development and training.

The card holder must inform us if they cease to participate at the required levels.

The Elite Card will expire at all sites after 1 year. It is up to the applicant to re-apply for the membership annually. Please note a reference will be required with each application.

ST ALBANS CITY & DISTRICT
ELITE CARD APPLICATION

Individual Details

Title: / First Name: / Surname:
Address:
Post Code: / E-mail:
Home Tel: / Mobile Tel:
Date of birth: / Gender M/F:
Type of user (Please delete as appropriate): Adult / Intermediate / Junior

Sport

Please can you give details of the sport you participate in and at what standard.

Sport:
If applicable please provide details of you specific position/ event:
For e.g. Goalkeeper, 100m freestyle
Standard at which you play and represent your sport (please circle):
National Regional County

Reference

Please provide your coaches details and confirm the type of reference provided.

Name of Squad:
Name of Coach:
Coach’s Email: / Coaches Contact Number:
Type of reference provided (please circle):
Headed Reference Letter / Optional Reference Form

Please circle the facilities are you interested in using?

Westminster Lodge Leisure Centre

Harpenden Sports Centre

Batchwood Sport and Golf Centre

Cottenswick Recreation Centre

Which of these groups do you consider you belong?

White / Mixed/Multiple
White British / White & Black Caribbean
Irish / White & Black Africa
Any other white background / White & Asian
Any other mixed background
Asian or Asian British
Indian / Black/ African/Caribbean/Black British
Pakistani / African
Bangladeshi / Caribbean
Chinese / Any other Black/ African/ Caribbean background
Any other Asian background
Any other ethnic group

Do you have a disability?

Yes / No (Please delete as appropriate)
If yes, please state (This is optional) ------

Additional Information

Do you receive any grant aid or other assistance e.g. from your club, local authority, national sporting agency or private sponsorship?
What pay and play activities will you access using the elite card?
How will these activities benefit your training?

Payment

Elite cards are given as a yearly fixed term membership with a charge of £10 per annum payable with your application.

Please specify below how you have paid this fee.

Cheques (Please make cheques payable to C-Salt LTD and enclose with application)

Cash (Please enclose with application)

BACS

Please reply to:

Elite Card

St Albans Sport and Health Team

St Albans District Council Offices

St Peter’s Street

St Albans

AL1 3JE

Telephone: 01727 819327

Declaration:

I declare that all information provided in this application form is true and correct and that I have read and understood the terms and conditions stated.

If under the age of 16, parent or guardian must sign this application.

Signed:……………………………………

Date:………………………

Please circle: Applicant (16+) / Parent / Guardian

By signing this application form you are agreeing to your details be passed on to our Leisure Providers 1Life and Everyone Active. If would prefer to not be contacted with marketing information from these companies, please tick.

Elite Card

Optional Reference Form

Reference Details
Name
Organisation / Club/ Squad
Position held in organisation
Applicant Details
Name of Applicant
Please state approx. duration the applicant has been a member within your organisation / squad
Can you confirm one of the following:
Juniors (aged 11 – 18) and Intermediates (aged 19 – 21)
The applicant is currently competing in his/her chosen sport at county level or above
Y / N
Adults - The applicant is currently competing in his/her chosen sport at national level or above
Y / N
Please provide a brief overview of the applicants sporting achievements within their squad to confirm their level of participation
Are you happy to recommend this applicant for an Elite Card?
(if no, please give reasons) / YES / NO
Are you happy to be contacted periodically to confirm the applicant is still competing at the required level? / YES / NO
Referees Signature / Please provide a squad/club stamp to verify this reference:
Date

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Company No. 7471672 | Charity Registration No. 1141094

Registered Office: 59-60 Thames Street, Windsor, SL4 1TX