Player’s age group: ………………….
FINCHAMPSTEAD JUNIOR NETBALL CLUB
Player Registration Form 2017-18
Name ...... Date of birth ......
Address ......
......
Postcode ...... Age on 1 September 2017 ......
Home Telephone no ...... Player’s mobile no ......
Parents’/Guardians’ names ......
*Emergency contact nos (*please supply at least 2 numbers)
Mum ...... Dad ......
other ......
Email address ...... School ......
PLEASE ENSURE YOUR EMAIL ADDRESS IS CORRECT. THIS WILL BE THE PREFERRED METHOD OF COMMUNICATING INFORMATION. PLEASE ADVISE YOUR COACH OF ANY CHANGE OF EMAIL ADDRESS.
MEDICAL INFORMATION
Is your child allergic to any drug or food? YES NO If YES please give details.
......
......
Does your child have any problems with sight, hearing or speech? YES NO If YES please give details
......
Does your child have any of the following medical conditions:
Asthma or bronchitis YES NO Allergy to any known medication YES NO
Heart condition YES NO Other allergies, eg material, plasters YES NO
Fits, fainting or blackouts YES NO Other illness or disability YES NO
Diabetes YES NO Travel sickness YES NO
Is your child taking any regular medication? YES NO
If the answer to any of these questions is YES, please give details:
......
Date of child’s last Tetanus injection ......
Name, address and telephone number of family doctor:
......
...... PTO/2
I give permission for the Club to administer the following commercially available medicines:
YES NO YES NO
Pain-relieving sprays ( ) ( ) Bongela mouth gel ( ) ( )
e.g. PR heat, PR freeze, Wasp-eze Paracetamol ( ) ( )
Antiseptic creams and ointments ( ) ( ) Travel sickness pills ( ) ( )
e.g. Dettol, Savlon, TCP
Please delete one of the following statements:
Either
ü If a girl requires emergency treatment and every effort has been made to obtain the prior consent of the parent or guardian, but where this is impossible in the time available, the coach or her appointed representative, acting in loco parentis, is authorised to give valid consent to such treatment, including anaesthetic or operation as may be recommended by the doctor.
Or
ü The Club is not authorised to give consent for any medical treatment.
In the event of any illness or medical treatment occurring after the return of this form, I undertake to inform Finchampstead Junior Netball Club.
PUBLICITY, VIDEO, ZOOM & CLOSE RANGE PHOTOGRAPHY CONSENT
From time to time we have the opportunity to publicise Finchampstead Junior Netball Club and its achievements in the local newspapers, on the Club’s website, Facebook page or other social media. As part of this publicity it is likely that photographs will be used to accompany the article in question. It is also possible that video footage may be taken during training and/or matches to assist coaches in planning sessions and assessing how to achieve progression for individual players within their squads.
Please tick the box if you DO NOT give permission for your daughter’s photograph to be used in any publicity, media or videoing of training/matches regarding Finchampstead Junior Netball Club. £
STATEMENT
Finchampstead Junior Netball Club does not accept any responsibility for any injury or damage sustained to any individual or their property.
I understand that information that I have provided will be held on a database and only available to Finchampstead Junior Netball Club coaches/managers.
I confirm I have read, and will ensure my daughter reads, and we agree to the Player’s and Parent’s codes of conduct published on the Club’s website: www.finchnetball.club
Signed ...... Date ......
Relationship to child ......
June 2017
2