Barton Hockey Club

Barton Hockey Club is proud to adopt the England Hockey Safeguarding and Protecting Young People Policy

CLUB MEMBERSHIP FORM 2017-2018

All prospective members and volunteers of Barton Hockey Club are required to complete this editable registration form electronically (except the highlighted boxes, which are for signatures on the paper copy) and return it with any relevant club fees prior to taking part in club activities of any kind. All details will be kept in accordance with data protection regulations and access restricted to authorised officers only.

SECTION 1: Member contact details
Title: / Surname: / First Name(s):
Date of Birth:
Home Address:[Do not add extra Carriage Returns – please use  to move to the subsequent lines.]
Post Code:
Mobile Phone Number:
Daytime Phone Number: / Evening Number:
Email Address:
SECTION 2: Membership Type
Member Type / Description / Annual Fees / Please tick
Full / Full Senior Membership / £80
Reduced / Full time students/retired/unemployed/U18 playing senior matches / £40
Junior / U18 attending junior training or junior matches / £0
Volunteer / Non playing role / £0
SECTION 3: Member Information
STUDENTS – What school/college or university do you attend?
Are you a qualified EH coach? (If yes, please state level.)
Are you willing to umpire matches? (If yes, please state if you are qualified and at what level.)
Would you be interested in being a team manager or coach? / (please state which)
Do you hold a valid CRB certificate?
Are you willing to be a club volunteer in some capacity? / (please state role)
SECTION 4: Medical Information and Consent (To be completed by PARENT or LEGAL GUARDIAN if under 18 years of age)
In case of emergency and as part of Barton Hockey Club’sresponsibility to its membership, all members are required to complete this medical information from as accurately as possible. Details will be held securely with access restricted to authorised officers only. Barton Hockey Club cannot be held responsible if relevant information has not been declared.
Name of Next of Kin: / Relationship:
Emergency Mobile Contact Number:
Doctor’s Name: / Surgery:
Doctor’s Phone Number:
As far as you are aware, are you allergic to anything or do you have an allergic reaction to any medication? (Please state)
Do you have any medical condition(s) that we should know about? (Please state)
Do you have any long term illnesses or injuries not mentioned above? (Please state)
Are you taking any regular medication? If so, for what reason?
DECLARATION: I consider [myself/my son/my daughter]* to be physically fit and capable of full participation, and agree to notify Barton Hockey Club of any changes to the medical information provided.
Furthermore, in the event or injury, I give permission for the Team Manager/Coaches appointed by Barton Hockey Club to obtain medical emergency treatment for [myself/my son/my daughter]*.
*Please delete as appropriate where indicated by an * then sign and date.
Signed:
Placeholder for signature on paper copy / Date:
Relationship to player (if appropriate):
SECTION 5: Other relevant information (MUST be completed for U18s by PARENT OR LEGAL GUARDIAN)
It is a requirement of Barton Hockey Club’spolicy that parents/legal guardian consent is provided for participation, transportation and photography. The Barton Hockey Club Members Code of Conduct and Safeguarding and Protecting Young People Policy are available in the handbook.
Please delete as appropriate where indicated by an * then sign and date at bottom.
TRANSPORTATION: I consent to my [son/daughter]* travelling to venues for matches and training, in transport provided by the club, which may include travelling in other players’ private cars.
PHOTOGRAPHY: In some environments, particularly competitions/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 matches and training by approved agents and/or officers of Barton Hockey Club. Such images shall only be used for publicity/training purposes in accordance with the Barton Hockey Club Members Code of Conduct and Safeguarding and Protecting Young People Policy, and I give consent for my [son/daughter]* to feature in such images. I hereby only grant approved agents the right to use the images resulting from the photograph/film shoots. This includes any reproduction or adaptations of the images for all general purposes, e.g. local newspapers, magazines and other promotional articles (including flyers) and the club’s website.
Signed:
Placeholder for signature on paper copy / Date:
Relationship to player:
SECTION 6a: Ethnicity
TICK / TICK / TICK
White British / Mixed – White & Asian / Asian or Asian British - Indian
White Irish / Mixed – Other / Asian or Asian British - Other
White Other / Chinese / Black or Black British - Caribbean
Mixed – White or Black Caribbean / Asian or Asian British - Pakistani / Black or Black British - African
Mixed – White or Black African / Asian or Asian British - Bangladeshi / Black or Black British - Other
Other Ethnic Group
SECTION 6b: Disability
TICK / TICK
Deaf / Physical Disability
Hearing Impaired / Learning Disability
Visually Impaired / Multiple Disabilities
Please add any additional relevant information that may be helpful.[Do not add extra Carriage Returns – please use ]
SECTION 7: Barton Hockey Club Behaviour Policy
Who does this apply to?
The content of this Code of Behaviour applies to all involved with the sport of hockey in Barton Hockey Club.
Expected minimum standards of behaviour and conduct
All individuals involved in hockey will at all times:
  • Respect the spirit of fair play in hockey. This is more than playing within the rules. It also incorporates the concepts of friendship, respect for others, and always participating with the correct spirit of the game.
  • Respect the rights, dignity, and worth of others:
  • Respect umpires, officials, coaches, players and spectators.
  • Conduct themselves in a manner that takes all reasonable measures to protect their own safety and the safety of others.
  • Promote the reputation of the sport and take all possible steps to prevent it from being brought into disrepute:
  • Accept success and failure, victory and defeat, with dignity.
  • Set a positive example for others, particularly young participants and spectators.
  • Protect themselves and others involved in hockey from verbal or physical abuse and threatening or intimidating behaviour.
  • Never use inappropriate language or gestures:
  • Never use foul, sexist, abusive, racist or any prejudicial language, or tolerate it from players and/or team officials.
  • Set a positive example for others, particularly young participants and spectators.
  • Abide by the EHB Safeguarding and Protecting Young People in Hockey Policy and Procedures and Good Practice Guidelines from EHB.
  • Abide by the EHB Equality Policy.
  • Abide by the EHB Anti-doping Rules.
With reference to discipline and respect in games; if a player receives three yellow cards in a season, their captain shall bring this to the attention of the Committee to discuss an appropriate course of action.
Discipline Orders
It shall be grounds for disciplinary action to be taken under these regulations, where a person over whom Barton Hockey Club has jurisdiction, is found to have harmed the safety and/or welfare of a person or people in hockey, or whose conduct (whether in hockey or not) is deemed to pose actual or potential risk of harm to the safety and/or welfare of a person or persons in hockey. In circumstances that are in breach of the Regulations set out above, Barton Hockey Club Committee has the power to impose the sanctions detailed below:
  1. The Committee to issue a written warning identifying a notice to improve behaviour otherwise further action will be taken.
  2. The individual concerned to personally pay any fine imposed on the club resulting from their breach of the code of conduct as set out above.
  3. a) An immediate interim suspension if the Committee, by reference to the regulations set out above, deem that it is appropriate to exclude an individual concerned from playing under the club’s jurisdiction.
b) The individual concerned to umpire for an appropriate team during the period of suspension or for as many games as the Committee deem necessary.
The factors to be taken into consideration are:
  • Whether the safety and/or welfare of young persons have, or could have, been put at risk of harm.
  • Whether the matter(s) are of a serious nature.
  • Whether a suspension is necessary or desirable to facilitate the conduct of any investigation or proceedings by England Hockey orany other authority or body, having regard in all cases for the need for any action to be proportionate.
The Committee shall, as soon as reasonably practicable, notify the individual concerned of the outcome of the Committee’s decision by having them attend a meeting with a Committee member and their Team Captain.
Upon completing the imposed sanction, the individual involved will be closely monitored for the remainder of the season. The Committee thereafter, at appropriate regular intervals, taking into particular consideration the facts and circumstances surrounding the case, can justify the continuation of the interim suspension, or relegate the player to the Badgers/Development teams, if no improvement has been evidenced.
Enforcement of Disciplinary Orders
Any breach of an interim suspension shall constitute grounds for further disciplinary action under these regulations.
Appeals Procedure
The individual concerned may lodge an appeal to initiate a re-evaluation of the actions imposed by the Committee by paying a fee of £20 with an accompanying letter.
If the Committee dismisses the appeal, the money is retained by the club and invested in the development fund. If the individual concerned wins their appeal, they can reclaim the value of their appeals fee.
I have read and understand the Barton Hockey Club Behaviour Policy and agree to abide by this Code of Behaviour.
Signed by Player (if 18+) / Date / Age of Player
Placeholder for signature on paper copy
Signed by Parent or Legal Guardian ofPlayers under 18 years of age /
Placeholder for signature on paper copy

WHEN ALL NON-HIGHLIGHTED CELLS HAVE BEEN COMPLETED, PLEASE:

  1. Email a saved copy to the Membership Secretary ().
  2. Print a paper copy (black & white is OK, preferably double-sided) sign it in ALL the appropriate places and return it to your team captain or Sue Welch (training coordinator).
  3. If any annual membership fees are due, please make payment by one of the following methods (in order of preference, with our clear preferred choice being BACS):
  4. BACS payment to NatWest Bank (Sort Code 52-10-35, Account 40443477) with a reference of the format “AMF J SMITH”, where the first 3 letters are “AMF” for full membership or “AMR” for reduced rate, followed by your initial and surname.
  5. Cheque payable to “Barton Hockey Club” handed in with the printed form.
  6. Cash handed in with the printed form. Make sure you get a receipt.

Note: Annual membership fees can be paid in full (by 30 Sep 2017) or in two equal instalments (first half by 30 Sep 2017 and second half by 31 Jan 2018).

1