CI LADIES HOCKEY CLUB

MEMBERSHIP FORM

All members are required to complete this form and return to the Membership Officer or Junior/Mini Coordinators with fees enclosed.

Membership Officer: Laura Hamilton.Return to Sara Houston, 48 Kyle Street, Belfast, BT4 1LS

Junior Co-ordinator:Russell Anderson, 6 Victoria Road, Holywood, BT18 9BA

Mini Co-ordinator: Janet Magill, 96 Circular Road, Belfast, BT4 2GE

Junior & Mini places are limited and while preference will be given to existing members they will be allocated on a first come basis so please return your forms ASAP.For U18s – this form MUST be fully completed by the parent / guardian who MUST ensure that the player fully understands the Player Code of Conduct.

PLEASE INDICATE MEMBERSHIP TYPE:

MEMBERSHIP / FEE / PLEASE TICK
Full Playing Member / £215
Student Player(Playing member at school or enrolled in a full time course of study) / £120
Veteran / £140
Non Playing Member / £90
Junior Player(Year 8-10, plus £1 per training night attended) / £90
Mini Player (P1-P7, plus £1 per training night attended) / £60

MEMBER DETAILS:

NAME / DATE OF BIRTH
ADDRESS
EMAIL ADDRESS / (Senior Club Players / 15yrs +)
(Parents for U18s)
CONTACT NUMBERS / HOME
MOBILE (Senior Club Players / 15yrs +)
MOBILE (Parents for U18s)
EMERGENCY CONTACT DETAILS / NAME
CONTACT NO.

CIYMS MEMBERSHIP

Please indicate if you / your daughter hold membership of another CIYMS Section e.g. Tennis

Delete as appropriate:Yes / NoSECTION:

SCHOOL DETAILS: (APPLICABLE TO SCHOOL AGE GIRLS)

SCHOOL / YEAR GROUP

HEALTH DETAILS:

Please indicate if you / your daughter has any health issues that we should be aware of e.g. asthma, allergies etc. Please include any details of any medication.

DISABILITY DETAILS:

Please indicate if you / your daughter has any disability that we may be able to make a reasonable adjustment for:

PHOTOGRAPHIC MATERIAL:

CI Ladies Hockey Club has adopted a policy in relation to the use of images of young people on their websites and in other publications as part of its commitment to providing a safe environment to young people. It is your responsibility to ensure that you are familiar with this policy.

AUTHORISATION & CONSENT:

-I authorise the CI Ladies Hockey Club (CILHC) coaching staff to administer basic first aid as deemed necessary in an emergency

-I authorise CILHC coaches to give the immediate necessary authority on my behalf for any medical or surgical treatment recommended by a competent medical authority, where it would be contrary to my daughter’s interest, in the doctor’s medical opinion, for any delay to be incurred by seeking my personal consent.

-I agree to pay for any damage caused by the misconduct or carelessness of my daughter to a third party or to property

-I agree not to hold CILHC responsible for any loss of any personal effects or money incurred by my child

-I authorise CILHC to use any photographic material for the purposes of the clubs promotion.

-I authorise CILHC coaches, captains and committee to communicate directly via mobile and email to those playing in senior club hockey (15yrs +)

All of our policies are available to download from our website

Please tick to indicate that you have downloaded, read and fully understood the policies outlined below. If you do not have access to the internet please let us know and we can provide you with a hard copy.

Policy / Please tick
Anti – Bullying
Code of Conduct – Players
Code of Conduct – Young Players
Guidelines for Parents
General Issues

PLEASE NOTE THAT ALL PLAYERS SHOULD ATTEND TRAINING WITH STICK,SHIN GUARDS, MOUTH GUARDS AND WATER. CLOTHING APPROPRIATE TO WEATHER CONDITIONS SHOULD BE WORN AS TRAINING WILL CONTINUE IN WET WEATHER.

I hereby agree to abide by the club constitution, policies and guidelines as outlined above and which can be found on the CILHC website. I understand that membership fees are non-refundable and cannot be pro-rated. Mini/Junior membership fees must be paidon, or before, the first night of the season. Senior membership fees are due by 1st October. Any senior player setting up a standing order must do so in agreement with the Club Captain and Treasurer, and notified by 1st October. I understand that I may not be selected to play if my fees are not paid by the agreed dates. Membership of CILHC will be at the sole discretion of the Management Committee.

Signed:

Player Name:

Fee Enclosed:£

Methods of Payment:Cash

Cheque (Please make cheques payable to CI Ladies Hockey Club)

Bank Transfer (Use player name as reference. Account No: 49380033, Sort Code: 98-00-60)