Membership Application Form Personal Details Title * First Name * Surname * Date of Birth * DD/MM/YYYY Address Line 1 * Address Line 2 Address Line 3 Town * County * Postcode * Email * Home phone Mobile phone * Next of kin details (please supply two next of kin contacts) First next of kin Name Relationship Address Mobile phone Home phone Second next of kin Name Relationship Address Mobile phone Home phone Medical History Do you have any medical conditions/illnesses that may affect your health, or endanger yourself/others whilst participating in club activities? * Yes No If 'yes', please provide details It is your responsibility to inform one of the club officers should any medical conditions become known or change. This information will be held in the strictest of confidence. I understand that its my personal responsibility to inform my climbing partners (on a meet or at a climbing wall) of any medical conditions that may effect my ability to safely climb or belay. * Climbing Safety Are you an experienced climber, and able to climb/belay safely and competently, or have you completed a 'learn to climb' course in the last 6 months and been signed off as an independent climber? * Experienced Climber Completed Learn to Climb course and completed independent climber competency. None of the above Please briefly describe your climbing/mountaineering experience. Not required for existing member renewals Privacy Policy Here at Chelmsford Mountaineering Club we take the privacy of our member’s data seriously and will only use your personal information for club administration purposes or for communicating with you about your membership. Only the Elected Committee Members, i.e. Chairman, Secretary and Treasurer or Committee Appointed Officers will be able to access your details. More information about how we look after your data can be found on the CMC Web Site at https://www.the-cmc.co.uk/privacy-policy. As a British Mountaineering Council-affiliated club we will provide your name, contact details and date of birth to the BMC to administer your membership of the BMC including your combined liability insurance cover. The BMC will use your data to communicate with you about your membership. The BMC will contact you to invite you to create a ‘Member Profile’ which, amongst other things, allows you to set and amend your privacy settings. More information about how the BMC uses data can be found at www.thebmc.co.uk/privacy. We will never share or sell your data without our prior permission. Declarations Please tick the boxes I, (new member's name) apply for membership of the Chelmsford Mountaineering Club. * I accept that climbing and mountaineering are activities with a danger of personal injury or death. I am aware of and shall accept these risks and wish to participate in these activities voluntarily and shall be responsible for my own actions and involvement. * Yes No I agree for my personal details(*) provided here to be held by the CMC in accordance with the CMC Privacy policy. * Yes No As the CMC is a BMC affiliated club, I agree for my personal details(*) to be provided to the BMC in order to administer my membership. * Yes No I agree to my next of kin details being held by the CMC and agree to my next of kin being contacted in the event of an emergency/serious injury. * Yes No I agree to be added to club communications such as email groups and whatsapp groups. * Yes No I acknowledge the Club’s constitution and disciplinary policy and agree to be bound by them. * Yes No Signed (member or parent/guardian) * Please type name. Date * DD/MM/YYYY Full name of parent/guardian (If new member is under 18) Thank you! If you’re a new member you’ll hear back from us shortly to confirm we’ve received it.
