Registration

Section 1 - MEMBER CONTACT INFORMATION

Title *

Mrs

Miss

First Name (s) *

Surname *

Address Line 1 *

Address Line 2

City *

County *

Post Code *

Date Of Birth *

Home Phone Number

Mobile Phone Number

Email *

Section 2 - MEMBERSHIP TYPE

Select Membership Type *

Full Senior Membership (Match Fee = £7.00) - £70

Full time students and U18s playing Senior Club Matches ( Match Fee = £4.00) - £35

Junior - No senior club match playing (Match Fee = £2.50) - £20

Fee includes £6 Family Sport Club membership. Deduct if paid this season. e.g. this is second child's form.

For family's with multiple players, the third player is 25% off, and any further players 50% off.

Section 3 - Member Information

(Information in this section is optional and will be used for club development purposes only)

STUDENTS – What school/college or university do you attend?

NON-STUDENTS – What is you occupation?

Would you be interested in learning to coach?

Yes

Already qualified coach

Can you please provide additional detail (of coaching level and interest in coaching at SHC)

Would you be interested in learning to umpire

Yes

Already umpire qualified

Can you please provide additional detail (level & interest in umpiring)

Would you be interested in being a team manager or club officer? (Please state)

Do you have any skills that you would wish to use to help develop the club? (e.g. web design, accounting, printing, planning, sponsorship, etc)

Section 4 - MEDICAL INFORMATION & CONSENT

(To be completed by PARENT or GUARDIAN if under 18)

In case of emergency and as part of the clubs responsibility to its membership, ALL club members are required to complete this medical
information form as accurately as possible. Details will be held securely with access restricted to authorised club officers only.

Next of Kin (name) *

Relationship *

Home Phone Number

Mobile Phone Number

Doctors Name

Surgery *

As far as you are aware, are you allergic to any drugs? (Please state)

Are you taking any regular medication? If so, for what reason?

Do you have any long term illnesses or injuries? *

Declaration

Declaration: I consider myself (my son/daughter) to be physically fit and capable of full participation and agree to notify the club of any changes to the medical information provided. Furthermore, in the event that I am injured I give my permission (for my son/daughter)* for the team managers/coaches appointed by SLAZENGER HC to obtain emergency medical treatment on my behalf.

Declaration: *

Date *

Relationship *

SECTION 5: UNDER 18 MEMBER CONSENT (TO BE COMPLETED BY PARENT/GUARDIAN)

It is a requirement of club policy that parental consent is provided for participation, transportation and photography. The SLAZENGER HC members Code of Conduct and Safeguarding and Protecting Young People in Hockey Policy are available in the club handbook. Please sign and date at the bottom.

TRANSPORTATION: I consent to my son/daughter* travelling to venues for matches and training by transport provided by the club which may include travelling in other players private cars.

PHOTOGRAPHY: In some environments, particularly adult competition it is impossible to control photography by external parties, however, I am aware that there maybe times that photographs and/or footage maybe taken during matches and training sessions by approved agents and/or officers of SLAZENGER HC. Such images shall only be used for publicity/training purposes in accordance with the SLAZENGER HC Safeguarding and Protecting Young People in Hockey Policy and Photography Policy and give consent for my son/ daughter to feature in such photos/ images. I hereby only grant approved agents the right to use the images resulting from the photo/film shoots. This includes any reproductions or adaptations of the images for all general purposes ie local newspapers, local magazines, other promotional articles (inc. flyers) and the club’s website.

Signed

Date

Relationship

Registration

Registration Form

Section 1 - MEMBER CONTACT INFORMATION

Section 2 - MEMBERSHIP TYPE

Section 3 - Member Information

Section 4 - MEDICAL INFORMATION & CONSENT

Declaration

SECTION 5: UNDER 18 MEMBER CONSENT (TO BE COMPLETED BY PARENT/GUARDIAN)

SECTION 6: ETHNICITY & DISABILITY

Registration

Registration Form

Section 1 - MEMBER CONTACT INFORMATION

Section 2 - MEMBERSHIP TYPE

Section 3 - Member Information

Section 4 - MEDICAL INFORMATION & CONSENT

Declaration

SECTION 5: UNDER 18 MEMBER CONSENT (**TO BE COMPLETED BY PARENT/GUARDIAN**)

SECTION 6: ETHNICITY & DISABILITY

SECTION 5: UNDER 18 MEMBER CONSENT (TO BE COMPLETED BY PARENT/GUARDIAN)