Junior Subscription Form 2014/15 - Harrogate Hockey Club
PLEASE COMPLETE ONE SUBSCRIPTION FORM PER PLAYER
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Player First Name *
Player Surname *
Age Group *
Player should be under the age of the age group they will be playing in as at the 1st September of any season.
Date of Birth *
enter as DD/MM/YYYY
Address Line 1 *
Please let us know if your contact information changes
Address Line 2
Address Line 3
Post Code *
Email address *
School attended *
Medical Information - medical conditions *
Please detail any medical conditions we need to be made aware of. (E.g. disability / allergies / dietary requirements / travel sickness) If none, enter 'none'
Medical Information - medical treatment *
Please provide details of any medical treatment including medication information. (E.g. inhaler and type) If none, enter 'none'
Emergency Contact 1 - name *
Please let us know if your contact information changes
Emergency Contact 1 - tel *
Please let us know if your contact information changes
Emergency Contact 2 - name
Emergency Contact 2 - tel
Emergency Contact 3 - name
Emergency Contact 3 - tel
Select Subscription Rate (rates valid from 23/2/15) *
Two payment option can be made by individual request only. Please contact the Junior Co-ordinator in the first instance. £45 subscription for only child and 1st child.  £40 subscription for each sibling (brother / sister).   £20 subscription for a committee member, junior coach, team manager, umpire with children playing only.
Payment options *
If you are paying by cheque, please put the players’ name/s on the back of the cheque and make it  payable to ‘Harrogate Hockey Club’. Send it to:  Junior Section Treasurer, Harrogate Hockey Club, Granby Hockey Centre, Ainsty Road, Harrogate, HG1 4AP. If you are paying by BACS - Sort Code: 30-93-91 Account no: 00313229. Add player’s name and age group / gender in reference name. e.g. JBermanU16B
Parental Consent Statement - DECLARATION *
My child is in good health and I consider them capable of taking part in activities at Harrogate Hockey Club.  I have completed the medical details and consent that in the event of any illness / accident, any necessary treatment can be  administered to my child, which may include the use of anaesthetics. I understand that in all cases the club / coaches will always  make every reasonable effort to contact parents in an emergency, but in the best interests of the child, a club representative is  hereby authorised to act In Loco Parentis in my absence. I also understand that while club personnel will take every reasonable  precaution to ensure that accidents do not happen, neither they nor the club can necessarily be held responsible for any loss,  damage or injury suffered by my child.
Required
Parental Consent Statement - TRANSPORTATION *
I provide consent to allow my child to travel to venues for matches and training, in transport provided by the  Club, which may include traveling in other players’ private cars.
Required
Parental Consent Statement - PHOTOGRAPHY *
In some environments, particularly at tournaments / matches, 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 tournaments/matches and training sessions by approved agents and/or officers of Harrogate Hockey Club. Such images shall only be used for publicity/ training purposes in accordance with the Harrogate Hockey Club Safeguarding and Protecting Young People Policy and  Photography Policy and I give consent for my child to feature in such photos/images. I hereby grant only 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, e.g. local newspapers, local magazines, newsletters, other promotional articles (including flyers) and the Club’s website.
Required
Video filming or taking any photos on Club premises *
Please note also that if you do wish to do any video filming or take any photos on Club premises you should request consent from  a member of the Management Committee beforehand. Contact details can be found in the Members Handbook or on our website.
Required
Ethnicity Information
This section is optional and will be used for development purposes only
Disability Information
This section is optional and will be used for development purposes only
Please add any additional relevant information:
For parents (please complete) *
Yes
No
I am interested in coaching and / or umpiring at training sessions and / or tournament days
I am interested in learning to become a coach and / or umpire to help with junior training and tournament days
I am willing to be a team manager for tournament days
I am interested in being an officer of the Club (committee member)
My company or workplace would be interested in sponsoring HHC
Please note that by clicking 'Submit' you are providing confirmation of all consents made; that the information provided is accurate and has been provided by a parent and / or guardian of the player being registered. *
Required
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