{"id":67,"date":"2018-11-11T19:29:25","date_gmt":"2018-11-11T19:29:25","guid":{"rendered":"http:\/\/www.brendaningle.com\/?page_id=67"},"modified":"2018-11-11T20:00:38","modified_gmt":"2018-11-11T20:00:38","slug":"membership","status":"publish","type":"page","link":"http:\/\/www.brendaninglefoundation.org.uk\/?page_id=67","title":{"rendered":"Membership"},"content":{"rendered":"<div id=\"usermessagea\" class=\"cf_info \"><\/div><form enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F67#usermessagea\" method=\"post\" class=\"cform membership \" id=\"cformsform\"><ol class=\"cf-ol\"><li id=\"li--1\" class=\"\"><label id=\"label--1\" for=\"cf_field_1\"><span>Your Name<\/span><\/label><input type=\"text\" name=\"cf_field_1\" id=\"cf_field_1\" class=\"single fldemail fldrequired\" value=\"Your Name\" onfocus=\"clearField(this)\" onblur=\"setField(this)\" title=\"\"\/><span class=\"emailreqtxt\">(valid email required)<\/span><\/li><li id=\"li--2\" class=\"\"><label id=\"label--2\" for=\"cf_field_2\"><span>DOB<\/span><\/label><input required=\"required\"  type=\"date\" name=\"cf_field_2\" id=\"cf_field_2\" class=\" fldrequired\" value=\"\" title=\"\"\/><span class=\"reqtxt\">(required)<\/span><\/li><li id=\"li--3\" class=\"\"><label id=\"label--3\" for=\"cf_field_3\"><span>Email<\/span><\/label><input type=\"text\" name=\"cf_field_3\" id=\"cf_field_3\" class=\"single fldemail fldrequired\" value=\"\" title=\"\"\/><span class=\"emailreqtxt\">(valid email required)<\/span><\/li><li id=\"li--4\" class=\"\"><label id=\"label--4\" for=\"cf_field_4\"><span>Address Including Post Code<\/span><\/label><textarea cols=\"30\" rows=\"8\" name=\"cf_field_4\" id=\"cf_field_4\" class=\"area fldrequired\" title=\"\"><\/textarea><span class=\"reqtxt\">(required)<\/span><\/li><li id=\"li--5\" class=\"\"><label id=\"label--5\" for=\"cf_field_5\"><span>Telephone Number<\/span><\/label><input required=\"required\"  type=\"tel\" name=\"cf_field_5\" id=\"cf_field_5\" class=\" fldrequired\" value=\"\" title=\"\"\/><span class=\"reqtxt\">(required)<\/span><\/li><li id=\"li--6\" class=\"\"><label id=\"label--6\" for=\"cf_field_6\"><span>Telephone Mobile<\/span><\/label><input required=\"required\"  type=\"tel\" name=\"cf_field_6\" id=\"cf_field_6\" class=\" fldrequired\" value=\"\" title=\"\"\/><span class=\"reqtxt\">(required)<\/span><\/li><li id=\"li--7\" class=\"\"><label id=\"label--7\" for=\"cf_field_7\"><span>Occupation<\/span><\/label><input type=\"text\" name=\"cf_field_7\" id=\"cf_field_7\" class=\"single\" value=\"\" title=\"\"\/><\/li><li id=\"li--8\" class=\"\"><label id=\"label--8\" for=\"cf_field_8\"><span>Email of parent\/carer of minor<\/span><\/label><input  type=\"email\" name=\"cf_field_8\" id=\"cf_field_8\" class=\"\" value=\"\" title=\"\"\/><\/li><li id=\"li--9\" class=\"\"><label id=\"label--9\" for=\"cf_field_9\"><span>Next of Kin\/Parent\/Carer<\/span><\/label><input type=\"text\" name=\"cf_field_9\" id=\"cf_field_9\" class=\"single\" value=\"\" title=\"\"\/><\/li><li id=\"li--10\" class=\"\"><label id=\"label--10\" for=\"cf_field_10\"><span> Next of Kin\/Parent\/Carer contact number<\/span><\/label><input  type=\"tel\" name=\"cf_field_10\" id=\"cf_field_10\" class=\"\" value=\"\" title=\"\"\/><\/li><li id=\"li--11\" class=\"textonly\">Health Questions In an emergency and also to establish your physical readiness to exercise please answer the following questions.  These will be treated in the strictness confidence;<\/li><li id=\"li--12\" class=\" cf-box-title\">Blood clotting disorders?<\/li><li id=\"li--12items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_12-1\" name=\"cf_field_12\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--121\" for=\"cf_field_12-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_12-2\" name=\"cf_field_12\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--122\" for=\"cf_field_12-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--13\" class=\" cf-box-title\">High or low blood pressure?<\/li><li id=\"li--13items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_13-1\" name=\"cf_field_13\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--131\" for=\"cf_field_13-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_13-2\" name=\"cf_field_13\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--132\" for=\"cf_field_13-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--14\" class=\" cf-box-title\">Elevated blood cholesterol?<\/li><li id=\"li--14items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_14-1\" name=\"cf_field_14\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--141\" for=\"cf_field_14-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_14-2\" name=\"cf_field_14\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--142\" for=\"cf_field_14-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--15\" class=\" cf-box-title\">Diabetes?<\/li><li id=\"li--15items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_15-1\" name=\"cf_field_15\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--151\" for=\"cf_field_15-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_15-2\" name=\"cf_field_15\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--152\" for=\"cf_field_15-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--16\" class=\" cf-box-title\">Chest pains brought on by physical exertion?<\/li><li id=\"li--16items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_16-1\" name=\"cf_field_16\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--161\" for=\"cf_field_16-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_16-2\" name=\"cf_field_16\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--162\" for=\"cf_field_16-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--17\" class=\" cf-box-title\">Epilepsy?<\/li><li id=\"li--17items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_17-1\" name=\"cf_field_17\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--171\" for=\"cf_field_17-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_17-2\" name=\"cf_field_17\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--172\" for=\"cf_field_17-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--18\" class=\" cf-box-title\">Dizziness or fainting?<\/li><li id=\"li--18items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_18-1\" name=\"cf_field_18\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--181\" for=\"cf_field_18-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_18-2\" name=\"cf_field_18\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--182\" for=\"cf_field_18-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--19\" class=\" cf-box-title\">A bone, joint or muscular problems?<\/li><li id=\"li--19items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_19-1\" name=\"cf_field_19\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--191\" for=\"cf_field_19-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_19-2\" name=\"cf_field_19\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--192\" for=\"cf_field_19-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--20\" class=\" cf-box-title\">Asthma or respiratory problems?<\/li><li id=\"li--20items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_20-1\" name=\"cf_field_20\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--201\" for=\"cf_field_20-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_20-2\" name=\"cf_field_20\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--202\" for=\"cf_field_20-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--21\" class=\" cf-box-title\">Any sustained injury or illness?<\/li><li id=\"li--21items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_21-1\" name=\"cf_field_21\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--211\" for=\"cf_field_21-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_21-2\" name=\"cf_field_21\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--212\" for=\"cf_field_21-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--22\" class=\" cf-box-title\">Any allergies?<\/li><li id=\"li--22items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_22-1\" name=\"cf_field_22\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--221\" for=\"cf_field_22-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_22-2\" name=\"cf_field_22\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--222\" for=\"cf_field_22-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--23\" class=\" cf-box-title\">Are you on any medication?<\/li><li id=\"li--23items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_23-1\" name=\"cf_field_23\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--231\" for=\"cf_field_23-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_23-2\" name=\"cf_field_23\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--232\" for=\"cf_field_23-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--24\" class=\" cf-box-title\">Has your doctor ever advised you not to exercise?<\/li><li id=\"li--24items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_24-1\" name=\"cf_field_24\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--241\" for=\"cf_field_24-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_24-2\" name=\"cf_field_24\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--242\" for=\"cf_field_24-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--25\" class=\" cf-box-title\">Are you of any reason not noted above why boxing may not be suitable for you?<\/li><li id=\"li--25items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_25-1\" name=\"cf_field_25\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--251\" for=\"cf_field_25-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_25-2\" name=\"cf_field_25\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--252\" for=\"cf_field_25-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--26\" class=\" cf-box-title\">Are you up to date with your tetanus?<\/li><li id=\"li--26items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_26-1\" name=\"cf_field_26\" value=\"Yes\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--261\" for=\"cf_field_26-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_26-2\" name=\"cf_field_26\" value=\"NO\" class=\"cf-box-b fldrequired\" title=\"\"\/><label id=\"label--262\" for=\"cf_field_26-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--28\" class=\" cf-box-title\">I have read the club rules and agree to abide by them. I will not hold the club or  coaches liable for personal injury. My personal effects and equipment are my own responsibility.<\/li><li id=\"li--28items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_28-1\" name=\"cf_field_28\" value=\"Yes\" class=\"cf-box-b\" title=\"\"\/><label id=\"label--281\" for=\"cf_field_28-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_28-2\" name=\"cf_field_28\" value=\"NO\" class=\"cf-box-b\" title=\"\"\/><label id=\"label--282\" for=\"cf_field_28-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--30\" class=\" cf-box-title\">Parent\/guardian; I agree for my child\u2019s image to appear in press and the media featuring the club\u2019s activities.<\/li><li id=\"li--30items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_30-1\" name=\"cf_field_30\" value=\"Yes\" class=\"cf-box-b\" title=\"\"\/><label id=\"label--301\" for=\"cf_field_30-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_30-2\" name=\"cf_field_30\" value=\"NO\" class=\"cf-box-b\" title=\"\"\/><label id=\"label--302\" for=\"cf_field_30-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--31\" class=\" cf-box-title\">Parent\/guardian; You agree for the club to seek immediate medical attention if your child should need it, including transfer to a hospital. <\/li><li id=\"li--31items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_31-1\" name=\"cf_field_31\" value=\"Yes\" class=\"cf-box-b\" title=\"\"\/><label id=\"label--311\" for=\"cf_field_31-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_31-2\" name=\"cf_field_31\" value=\"NO\" class=\"cf-box-b\" title=\"\"\/><label id=\"label--312\" for=\"cf_field_31-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--32\" class=\" cf-box-title\">I have completed the health questionnaire accurately and will advise the club of any change in my\/my child\u2019s medical condition that may affect my\/my child\u2019s ability to participate in the boxing training.  I give permission for my details to be stored on a secure computer database and for the club to send me emails.<\/li><li id=\"li--32items\" class=\"cf-box-group\"><input type=\"radio\" id=\"cf_field_32-1\" name=\"cf_field_32\" value=\"Yes\" class=\"cf-box-b\" title=\"\"\/><label id=\"label--321\" for=\"cf_field_32-1\" class=\"cf-after\"><span>Yes<\/span><\/label><input type=\"radio\" id=\"cf_field_32-2\" name=\"cf_field_32\" value=\"NO\" class=\"cf-box-b\" title=\"\"\/><label id=\"label--322\" for=\"cf_field_32-2\" class=\"cf-after\"><span>No<\/span><\/label><\/li><li id=\"li--35\" class=\"textonly\">Please answer the question below <\/li><li id=\"li--37\" class=\"\"><label for=\"cf_field_37\" class=\"secq\"><span>Ten minus five equals<\/span><\/label><input type=\"text\" name=\"cforms2_question_and_answer\" id=\"cf_field_37\" class=\"secinput fldrequired \" title=\"\"\/><input type=\"hidden\" name=\"cforms2_question_and_answer\/hint\" value=\"2\"\/><\/li><\/ol><fieldset class=\"cf_hidden\"><legend>&nbsp;<\/legend><input type=\"hidden\" name=\"cf_working\" id=\"cf_working\" value=\"<span>One moment please...<\/span>\"\/><input type=\"hidden\" name=\"cf_failure\" id=\"cf_failure\" value=\"<span>Please fill in all the required fields.<\/span>\"\/><input type=\"hidden\" name=\"cf_customerr\" id=\"cf_customerr\" value=\"y\"\/><\/fieldset><p class=\"cf-sb\"><input type=\"submit\" name=\"sendbutton\" id=\"sendbutton\" class=\"sendbutton\" value=\"Submit\" \/><\/p><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-67","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"http:\/\/www.brendaninglefoundation.org.uk\/index.php?rest_route=\/wp\/v2\/pages\/67","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.brendaninglefoundation.org.uk\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/www.brendaninglefoundation.org.uk\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/www.brendaninglefoundation.org.uk\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.brendaninglefoundation.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=67"}],"version-history":[{"count":2,"href":"http:\/\/www.brendaninglefoundation.org.uk\/index.php?rest_route=\/wp\/v2\/pages\/67\/revisions"}],"predecessor-version":[{"id":69,"href":"http:\/\/www.brendaninglefoundation.org.uk\/index.php?rest_route=\/wp\/v2\/pages\/67\/revisions\/69"}],"wp:attachment":[{"href":"http:\/\/www.brendaninglefoundation.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=67"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}