Watford Joggers are affiliated to the South of England Athletic Association and are required to log these details for insurance purposes.

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Date:

 

 

Name:

 

 

Address:

 

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Telephone number:

Home:

 

Mobile:

 

Email address:

 

 

 

Date of birth:

 

 

£2.00 Paid?    Y/N

 

Emergency contact name:

 

 

Emergency contact number:

 

 

Do you have a medical condition that the club should be aware of?       

 

(Please give details - i.e Epilepsy, diabetes,  Heart Condition etc)