City Hockey Club Registration Form 2018

Are you new to Hockey?*
Are you a returning player to City?*
Preferred Grade*
Have you played for another club in the last 5 years?*
If YES, Clearance is required one week prior to start of play. Please provide details below
Name of club?
Association?

Club Volunteer Position –Coaching, Managing, Umpiring, Fundraising, Social Committee.

It is very important that we have club members contributing to the development and function of our club. Everyone is asked to assist with at least one job.
Specify Positions(s) you are able to assist with
Medical Information – please specify any relevant medical information eg Dizziness, fainting, epilepsy, heart conditions, allergies, hearing problems…
Doctor*
Phone Number

Area CodePhone Number

If under 18 years Parent/ Guardian details are required. Please provide name below:
Phone Number

Area CodePhone Number
Declaration: As a member of the City Hockey Club I have checked my details and in signing this form agree to abide by the rules, regulations, policies and responsibilities as set down by the City Hockey Club Executive Committee.

I will partake as a member of the City Hockey Club in a responsible manner and pay all fees as stipulated by the Committee.

I agree that I will pay all Hockey NSW fees prior to the first game of play and all City Club and Association fees by 31st May 2018 in full or as per my signed payment schedule agreed by the City Hockey Club Executive Committee. I understand if I fall behind on my fees I (or my child) will not be able to take the field.

I also agree to abide by the Rules and By Laws of the Hockey New England Hockey Association Inc. and to conduct myself in a manner that will not bring the game or the Association into disrepute.

I also authorise the coach or medical person to obtain appropriate medical treatment if any incident arises.
I Agree to the terms and conditions above (Parent/Guardian to agree if under 18 years)

No, ThanksI Agree
I hereby give permission for me or my (son/daughters) name and/or photo to be used on material provided by the City Hockey Club for the promotion of the club and/or team/sport, such as in newspapers, publicity fliers, on the web-site etc.
AgreeDisagree
Should be Empty:

City Wasps Registration Form 2018