INTO HOCKEY REGISTRATION FORM

Please use this form to register your interest for the Into Hockey sessions at Basildon Hockey Club. These sessions will take place on the 11th and 13th April from 7-8.30pm at the Basildon Sporting Village Astro. All attendees are required to complete this registration form prior to taking part in the sessions. In the interest of the welfare of our Members, any players who have not completed this form will not be allowed to take part in the sessions until it has been completed.

* = Required

Are you completing this form as a Parent/Guardian on behalf of a player who is under 18?

All players under 18 attending these sessions must have this form completed for them by a Parent or Guardian

Which sessions are will you/your child be attending? *

Are you/your child an exisiting Basildon Hockey Club member? *

If your details have changed since you completed your membership form at the start of the season please select No to re-enter your details.

SECTION 1: PLAYER INFORMATION

Title *

First Name(s) *

Last Name *

Gender

Date of Birth *

SECTION 2: CONTACT INFORMATION

Home Phone

Mobile Phone *

Email Address *

Address Line 1 *

Address Line 2

Town

Postcode *

SECTION 3: EQUIPMENT

Please bring a gum shield and shinpads to the sessions if you have them.

Do you/your child need to borrow a hockey stick?

Have you played hockey before?

SECTION 4: MEDICAL INFORMATION & CONSENT

In case of emergency and as part of the Club's 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

Full Name*

Relationship *

Mobile Phone *

Doctor Information

Doctor's Name *

Surgery *

Phone *

As far as you are aware, are you/your child allergic to any drugs? *

If yes, please state

Are you/your child taking any regular medication? *

If so, for what reason?

Do you/your child have any long-term illnesses or injuries? *

If yes, please state

SECTION 5: DECLARATION & CONSENT

DECLARATION

I consider myself/my child 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/my child is injured I give permission for the coaches appointed by Basildon Hockey Club to obtain emergency medical treatment on my behalf.*

CODE OF CONDUCT

The BHC Code of Conduct can be found here. All attendees must agree to follow these rules of conduct.*

PHOTOGRAPHY CONSENT

Photographs and/or footage may be taken at these sessions by approved agents and/or officers of Basildon HC. Such images shall only be used for publicity/training purposes. The following consent allows Basildon HC to share images which include yourself/your child on social media platforms, the Club website, flyers and leaflets and in printed media (for example team photos in the local newspaper) in order to promote the hockey club.

I hereby give consent for myself/my child to feature in such photos/images and 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 i.e. local newspapers, local magazines, other promotional articles (inc. flyers) and the Club's website. *