www.matlockhockey.co.uk
2017 / 2018 Season
Membership form:
Members should return this form with payment by the 31st July 2017 to Lisa Beacham, Rose Cottage, Main Street, Birchover, Matlock, DE4 2BN. Please make cheques payable to MBHC.
Membership is payable in instalments by cheque. The cheques must all be submitted with completed membership form and pre-dated, ensuring payment is completed by 30th September 2017.
Payment must be prompt for insurance purposes and be received prior to league games commencing, failure to do so will result is individuals being ineligible to play until the outstanding membership fees have been paid.
Address and phone lists will be updated with this information. This will be made available to club officials who may need to contact you. Please advise below if you wish your details to be removed from the club database.
Type of Membership (please circle):
· Full (£115)
· Student / Apprentice (£75)
· Concessionary / Job Seeker (UB40) / Special Circumstance agreed by executive committee (£75)
· Junior Members 11-18yrs, Year 7 to 13 in compulsory full-time education from season start (£50)
· Social (£40) allows you to play a maximum of 5 games
· Family – (£145) Defined as a mother & one or more daughters U21 in full time education
· Under 11 (£5)
All players’ fees will increase by £10 after 30/09/2017.
Can all players who are not registered with the Midland League send a digital photograph to your captain. If you are unsure if this refers to you please speak to you captain.
Name: / Date of birth:Address:
Home number:
Work number:
Email address: / Mobile number:
Join our Facebook page, Matlock Baileans Hockey Club. Please be aware that you are legally required to be 13 year of age or over to use Facebook.
I agree to my details being included in the club database on the understanding it will only be used for matters relating to the hockey club.
Please tick box below if you do not want your details included in the club database
Please tick box below if you do not want your name or photograph to feature on the Club website.
www.matlockhockey.co.uk
2017 / 2018 Season
Parental Consent Form – To be completed for all Players U18
I consent to my daughter ………………………………………………, Date of Birth………………………… playing hockey with Matlock Baileans Hockey Club during the 2017 / 2018 season, and being transported to and from matches in private cars. I am aware of the nature of the game and whilst I understand every care will be taken, I accept that in the event of an accident I cannot necessarily hold the club responsible. My daughter is in good health and I consider her to be capable of taking part. In the case of an accident or illness whilst away from home, I consent to any necessary medical treatment which may include the use of anaesthetics. I authorise basic First Aid to be administered as necessary.
Signed: …………………………………… Parent/Guardian
Name: ……………………………………
Address: ……………………………………
……………………………………
……………………………………
Contact No: ……………………………………
Email: ……………………………………
In the case of no response at this number I may be contacted through:
Second Contact Name: ……………………………………
Contact No: ……………………………………..
In your child’s interest, it is vitally important that the team captain should know whether she suffers from any illness which may affect her participation or require medication, e.g. diabetes, epilepsy, asthma or allergy. Please give details of any medication taken, such as tablets, inhalers, epipen etc.
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
Family Doctor’s Name: …………………………………………………
Address: …………………………………………………
…………………………………………………
During the course of a normal season photos appear in the local press, on the club web site and occasionally videos are taken for coaching purposes. If you object to your child’s image being used for this purpose please tick box
Signed: …………………………………… Parent / Guardian
All the information provided will only be used in the best interest of your child and full confidentiality is assured.