HORSHAM HOCKEY CLUB

COLTS MEMBERSHIP FORM

SEASON 2017-2018

Forename(s) /

Surname

Date of Birth
(dd/mm/yyyy) /

Age(on 1st Sept 2017)

/

Team Age group

/ Under _____’s
Membership Amount: / Membership fee with details of any discounts:
Parents/ Guardians
Home Address / Post Code
School
Contact details / Telephone Numbers / Email address
Home
Mobile (s)
Medical information Yes No
Does the player have any allergies? (Please state) *□ □
Does the player currently have any illness or injury? □ □
Is the player regularly taking prescribed drugs?□ □
If you answer yes to any of these questions please provide details below or on a separate sheet
Doctors Name & Surgery Address & Phone Number:

Declaration

I/we give permission for my child (named above) to attend training and to represent Horsham HC during 2015/16 season (in friendly matches, competitive matches and tournaments). /

Tick

□

Child Protection

I/we give permission for the club to take photographs and to publish match reports in which players are identified by name. This includes club website and social media.

/ □

Medical Treatment

I/we give permission for club officials to provide first aid to my child in the event of illness or injury.

I/we understand that whilst the club’s coaches, officials and helpers will take all reasonable care and precautions to ensure the health and safety of players, they cannot be held responsible for any loss, damage or injury suffered by children whilst traveling to and from fixtures or whilst participating in matches or training sessions.

/ □
□
Contact Details: I give permission for my child’s/my contact details name, telephone number and e-mail address to be given out to other parents of players normally in their team.
/

□

Code of Conduct

I/we confirm that my child (named above) has read and agrees toabide by the rules, regulations and Codes of Conduct of Horsham Hockey Club (the Club) available on the Club website I/we understand The Club reserves the right to cancel membership without refund in the event that conduct, on or off the pitch, is deemed by The Club to be unacceptable.

/ □
Signed: (Player): ______Date: ______
Signed (Parent or Carer): ______Date: ______
Name (Print): ______

Colts Membership Fees 2016-2017

(Sunday, Midweek, Inc Sunday Match Fee)

Age Group / Membership Fee
Under 18 / £105.00
Under 12’s, U14’s & U16’s / £165.00
U8’s & U10’s / £100.00
  • Any player that plays in a Senior Saturday match, i.e. Hotshots/Hotstars/2’s etc will have to pay match fee of £7.00 on the day.
  • Sibling Discount:
  • Eldest Child pays full price
  • First sibling receives a 25% discount
  • Further siblings receive a 5% discount

Colts One-Off payment

This payment will only benefit those colts that are playing weekly Senior Saturday matches that involves a match fee, i.e. Hotshots/Hotstars/2’s etc.

Age Group / Fee / Payment Breakdown
U18 One-off payment / £230.00 / Pay £120.00 by 30 Sept, then balance of
£55.00 by 30th Oct & 30th Nov 2017
U16 One-off payment / £290.00 / Pay £170.00 by 30th Sept, then balance of £60.00 by 30th Oct & 30th Nov 2017

This payment option is calculated so that players get up to 4 league matches free, plus any additional friendly matches or other training sessions.

Please return Membership Forms to Sue Chinn:

  • Colts on a Sunday morning
  • Post – 24 Queensway, Horsham, West Sussex, RH13 5AY
  • Email:

CHEQUES payable: HORSHAM HOCKEYCLUB

BACS payment: Horsham Hockey Club

Lloyds TSB

Sort code: 30-94-41 Account:00265789

(Reference: CHILDS NAME and CHILD’s AGE GROUP)

** It is really important that you reference the payment!