MIXED SECTION of the Leicestershire & Rutland Hockey Association LRHA1 Sheet

‘PRF’ PLAYER REGISTRATION FORM for Season 2018 / 2019

a)ALL PLAYERS: must register by completing & signing a PRF with SECTION C ‘countersigned’.

b)Exception: If the Player is registered on the ‘Club’ Master Registration List by Monday 22ndOct. 2018

c)A ‘Club File’ of the Player Registration Forms ‘PRF & MRL’ must be securely stored by the club.

d)The ‘Club File’ isyour ‘Player Registrations Evidence’ to the Mixed Section & Insurer Company.

e)Insurance Underwriters & LRHA Mixed Section Inspection Requirement:

The ’ClubFile’ must be available at all times for inspection by these two bodies.

SECTION A: NAME OF ENGAGING CLUB - please print details.

Full club name:

I confirm that the Engaging Club agrees to and accepts this registration.

Signature of the Club Secretary or Club Official please print name.

Date signed:

Transfer player details to the ‘Email NOTIFICATION FORM’ and submit as instructed

SECTION B: REGISTERING PLAYER TO FILL IN THIS PART - please print details.

Surname:

First names:

Female or Male:

Date of Birth:

Address in full:

Postcode

Telephone No:

Mobile No:

Email address:

A copy of the Management Regulations and the Playing Regulations of the LRHA Mixed Section has been handed to me and BEFORE signing this formI agree to abide by them.

I declare that I do not owe money and / or kit to any LRHA Mixed Section Club.

By signing this form I register as a Player for the above named Club the LRHA Mixed Section.

Player Declaration Note:

I have not registered or played for any LRHA Mixed Section Club Season 2018 / 2019.

I did not play or register for any other Mixed Section Club during Season 2017 / 2018.

GDPR – Consent Requirement:

I agree to any personal details in this form being used for the administration of the LRHA Mixed Section, Leicestershire & Rutland Hockey Association LRHA and insurance purposes (Please tick the box to consent)

Player’s Signature:

Date signed: NOTE: I CAN PLAY ONLY FOR THE ABOVE CLUB!

SECTION C ‘COUNTERSIGN’.Mandatory as stated in Handbook PR 5 a) iv).

The Official below shouldcheckthis form has been correctly filled in, the New Player’s name is listed on the Match Card and the New Player has signed the Match Card.

If details are found to be correct, a), or b) or c) to please sign and print name

a)Mixed Section EC member:

b)Umpire:

c)Opposition Captain:

Issue 1RJBPlayerRegistrationFormSeason 2018 / 192nd July 20181 Sheet 1 of 1