Lydney Hockey Club | Field Hockey Club based in Lydney in ...



4308475-328930lydneyhockey. Lydney Hockey Club @lydneyhc00lydneyhockey. Lydney Hockey Club @lydneyhc-190500-43815000LYDNEY HOCKEY CLUB2020 – 2021 SeasonAll players wishing to participate in playing or training with Lydney Hockey Club in the season 2020 – 2021 are required to complete the information below and return this form as soon as possible. Please give or return the form to Treasurer, Marcus Jones.MEMBERSHIP AND CONTACT DETAILSMEMBER’S NAME: Date of Birth (to comply with EH requirements): ETHNICITY – not nationality (to comply with EH requirements):ADDRESS: POSTCODE: EMAIL ADDRESS: LANDLINE NUMBER: MOBILE NUMBER: EMERGENCY CONTACT NO: ANY MEDICAL CONDITIONS: QUALIFICATIONS (please give full details, as appropriate): First Aider:Hockey Coach (please state Level and Coaching number): Hockey Umpire (please state level and umpiring number):Other relevant qualifications:PAYMENT DUE (please circle membership category)Category of memberBirth years(*) Annual SubscriptionACADEMY2008 or after?35 (per term)YOUTH (VIXENS, BADGERS)2004-2007?75STUDENTS (in f/t education) 2003 or beforeADULTS2002 or before (if not in category above)?100 FAMILY (*)N/ASee belowASSOCIATE2002 or before?35 (max 5 matches)[TREASURER’S USE ONLY]FEE RECEIVED - ?.......................DATE PAID……………….…2020CHEQUE NUMBER.......................(*) see below:Where an adult and a child (defined as Student in the table above) in the same family are both playing league hockey, the child shall pay half the due annual subscription.Where a member chooses not to play at weekends but only to come to training, he/she shall pay ?4 (?2 for youths and f/t students) on each occasion as well as the appropriate annual subscription. Unemployed adults shall be required to pay half subs and half fees while they remain unemployed. Please make representation to our Chairman.Students returning from University/College and those starting the season late shall be entitled to a reduced pro-rata subscription to be decided by the Treasurer on an individual basis or may join as an associate member (see above). Your cheque for the appropriate subscription should be sent to: Vectis. New Road, Bream, GL15 6HH. Please make cheques payable to ‘Lydney Hockey Club’ and attach them to this completed form.Cheques only, please. No cash will be accepted unless by prior agreement from the Treasurer. Please Note failure to supply a completed form and make payment by midday on October 23rd 2020 will result in ineligibility for team selection, due to the fact our required insurance cover will be invalid. I agree to complete an England Hockey “Player Participation Agreement” prior to attending training sessions or playing League games.SIGNED: DATE: 2020Please sign attatched permission slip for the use of photograghs and videos. This must be signed and returned with the membership form.I authorize the coach or captain of Lydney Hockey Club or person who is trained in the basics of first aid to give me/ my child first aid when appropriate. This includes the giving of age appropriate pain relief (e.g calpol/ paracetamol/ ibuprufen).I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for me/my child, However, if I cannot be reached, I hereby authorize Lydney Hockey Club to transport me/my child to the nearest medical care facility and to secure necessary medical treatment for me/my child. Doctor's Name: Address: ___________________________________________________________________ Telephone: _________________________________________________________________ Allergies: __________________________________________________________________________Chronic Health Conditions: ___________________________________________________________________________ Regular medications taken: ___________________________________________________________________________Emergency Contacts (First to be contacted in case of an emergency)Name :________________________________________________________________Phone (m) ________________________________________________________Phone (w) _______________________________________________________(Second to be contacted in case of an emergency)Name :________________________________________________________________Phone (m) ________________________________________________________Phone (w) _______________________________________________________MEMBER NAME: SIGNED: DATE: 2020 ................
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