Romsey Hockey Club: Membership Form

SECTION: Name and Initial Questions

Name*

FirstLast

Have you completed an online membership form before?*

Yes but my personal details have changed
No
Yes

If your name, address, email or phone number have changed then please choose the first option above.

What has changed?

Name?
Address?
Phone numbers?
Email address?

Is the member registering over 18?*

Yes
No

Has there been a change in medical or next of Kin status?*

Yes
No

If you have changes in your medical status or next of Kin contact detail then please choose the first option above.

Facebook*

Already a friend on facebook
Wish to be Friend
Do not wish to be a Friend

Facebook users must be over thirteen years of age to be registered. Please be aware of the dangers of publishing personal details on the web and the Club rules that we follow when publishing on our Romsey Hockey Club Facebook page.

SECTION: MEMBER CONTACT INFORMATION

Title

Address*

Street AddressCityState / Province / RegionZip / Postal Code

Date of birth*

(enter dd/mm/yyyy or select from the dialog)

Home Phone*

Mobile Phone

Email*

You may provide more than one email by separating them with a comma. This may be useful if you need club messages to be sent to several addresses. E.g. me@gmail.com, mum@gmail.com, dad@gmail.com

SECTION: MEMBERSHIP TYPE

Choose your membership type*

SENIOR
YOUTH/STUDENT
JUNIOR
NON PLAYER

SENIOR - £100 : Full Senior Membership (Match Fee - £7.00)
YOUTH/STUDENT - £60 : Full time Students and U18s playing Senior Club Matches (Families with 2 youth members £100 and three £120)
JUNIOR - £60 : The junior fee includes all Junior sessions from September to April plus Full junior membership.
NON PLAYER - : For non playing coaches, parents & friends of Club etc. (includes subscription to news letters)

SECTION: MEMBER INFORMATION

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

Photo

You may submit your photo with this form in jpg, gif, png or pdf format. Alternatively send a photo with your payment.

Students - what school, college or University do you attend?

Non-students - What is your occupation (optional)?

Would you be interested in learning to coach and or umpire? (please state)

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

What skills do you have that could help develop the club? (e.g. web design, accounting, printing, sponsorship, etc.)

Do you have a Current First Aid skills?

Yes

If you ticked the First Aid box, what certificate or training do you have?

SECTION: 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

Relationship

Mobile Phone

Doctors Name

Surgery

Phone

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 illness or injuries?

Declaration*

Signed

Please tick to indicate that you agree to the following: 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 Romsey Hockey Club to obtain medical treatment on my behalf.

SECTION: UNDER 18 MEMBER CONSENT

(**TO BE COMPLETED BY PARENT OR GUARDIAN**)

It is a requirement of club policy that personal conset is provided for participation, transportation and photography. The Romsey Hockey Club members Code of Conduct and Safeguarding and Protecting Young People in Hockey Policy are available in the club handbook.

TRANSPORTATION : I consent to my son/daughter* travelling to venus 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 may be times that photographs and/or footage may be taken during matches and training sessions by approved agents and/or officers of Romsey Hockey Club. Such images shall only be used for publicity/training purposes in accordance with the Romsey Hockey Club 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 of the images for all general purposes in local newspapers, local magazines, other promotional articles (inc. flyers) and the club's website.

Under 18 member consent*

Signed

Please tick the box to give your consent.

Under 12 declaration*

Member not under 12
Signed

I declare that I will support my child and coaches whilst at training sessions or matches by either being available myself or providing a named parent to provide support for my child. The name of supporting parent will be required to be registered on the day.

Promise to support the club*

My child will be available for both home and away matches
That I will volunteer to help with transport to away matches

Parent Club Guide*

I have read the Parent Club Guide

Please read the Parent Club Guide available on the web site. Link on the home page. (Do not navigate away from the form)

Name (of parent/Guardian)*

Date

(enter dd/mm/yyyy or select from the dialog)

Relationship*

SECTION: Register 2011/2012 Season

I declare that I wish to be a Romsey Hockey Club Member for the 2011/2012 Season. That I will adhere to rules of the Club, the rules of hockey and uphold sense of fair play. I promise to treat other club members, coaches, players of clubs and umpires with respect that their position deserves.

Declaration*

Signed

SECTION: ETHNICITY & DISABILITY

Whilst it is not compulsory for the following sections to be completed, the paragraph below explains why this personal information is considered to be important

Sport can and does play a major role in promoting the inclusion of all groups in society. However, inequalities have existed within sport particularly in relation to gender, race and disability. Sport England and England Hockey are committed to promoting and developing sports equity, which is about fairness in sport, equality of access, recognising inequalities and taking steps to address them. By monitoring the profile of people in sports clubs, national governing bodies of sport and Sport England can identify any issues relating to under representation of different groups and can develop strategies to ensure that all people have an opportunity in the future to develop and progress in sport.

England Hockey requests this data from clubs as part of the annual affiliation process and completing this data accurately enables the club to give an accurate picture to England Hockey on our membership.

Please select the choice that best describes your ethnicity