TRAFFORD JUNIOR NETBALL CLUB.

Affiliated to England Netball

A Member of Youth Clubs (UK) Ltd

Club President

Jean Leigh

Club Secretary Club Chairman Club Treasurer

Pat Evans Sandy Castell Jane Grant

Monday 18th July 2016

MEMBERSHIP FORM 2016/17

All prospective members of Trafford Junior Netball Club are required to complete this registration form by 20 August 2016 and have completed a direct debit mandate for the first payment on 1st September 2016. This payment will be the registration fee plus the first monthly training fee subscription relevant to your age group. If the first payment is not honoured or subsequent monthly payments are not honoured then you will not be allowed to play in club matches or attend training. Existing direct debits will be automatically renewed.

All details will be kept in a secure database with access restricted to authorised officers.

If you are under 18 your parent or guardian must complete the information where indicated and sign the boxes on pages 2 & 3 on the form before it is returned. Please make sure all parts are completed and selections deleted where appropriate i.e. where giving consent or not. If not completed fully the form will be returned to you and this may prevent your child participating in matches.

We will also use this information to ensure that you are kept informed about club news and events.

CLUB MEMBERSHIP DETAILS

Contact Information

Name (full name of member)
Address (home) / Postcode:
Daytime phone number (of parent/carer): / Evening/home phone number :
Mobile (of parent/carer) / 1)
2)
Email (of parent/carer) / 1)
2)
Date of Birth (of member)
Mobile (member where aged 16 or over)
Email (member where aged 16 or over)

N.B. Any individual text or email to member aged 16+ will be duplicated to parent/carer and Club Safeguarding Officer

AFFILIATION AND MEMBERSHIP FEES DUE FOR YEAR 2016/2017

Affiliation & Membership / Description / Fee / Tick
1.  EN Affiliation Fee (incl. GMCNA & NW Netball Fees) - non refundable / 18 and under (on 1.9.2016)
14 and under (on 1.9.2016)
11 and under (on 1.9.2016) / £18.60
£10.85
£7.60 / [ ]
[ ]
[ ]
2.  Club Fee / Membership Fee for all age groups / £25.00
All affiliation fees, club membership, training subs and direct debit fees are collected only by direct debit for all age groups – All Affiliation Fees and Club Membership Fees must be paid in full by 1st September 2016 at the latest

Please see the website for training fees for respective age groups.

Please tick the box that best describes your ethnicity : optional

White British / Asian or Asian British – Pakistani
White Irish / Asian or Asian British – Bangladeshi
White Other / Asian or Asian British – Other
Mixed – White and Black Caribbean / Black or Black British – Caribbean
Mixed – White and Black Asian / Black or Black British – African
Mixed – White and Black African / Black or Black British – Other
Mixed – Other / Chinese
Asian or Asian British – Indian / Other Ethnic Group

MEDICAL INFORMATION - mandatory

To be completed by the parent/carer

Please detail below any important medical information that our coaches/Junior Coordinator should be aware of

As far as you are aware, are you allergic to any medication? (Please state)
Are you taking any regular medication? If so, for what reason?
Do you have any long-term illnesses or injuries?
YES/NO / YES/NO
Deaf / Physical disability
Visually Impaired / Learning disability
Hearing Impaired / Multiple disability
If yes to any of the above please add any additional relevant information

EMERGENCY CONTACT DETAILS - mandatory

To be completed by the parent/carer

Please insert the information below to indicate the person(s) who should be contacted in event of an incident/accident.

Contact name : / Relationship to member : / Emergency phone no.
Doctor’s Name : / Surgery: / Doctor’s phone number :

Declaration: I consider my son/daughter to be physically fit and capable of full participation in the activities of the club and agree to notify Trafford Junior Netball Club of any changes to the medical information provided. I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately. Furthermore, in the event of injury/illness to my son/daughter I give my permission for the team managers/coaches appointed by Trafford Junior Netball Club to obtain emergency medical treatment.

Name of Parent/Carer
Signature / Date:

In signing this form I confirm receipt of the Codes of Conduct for players and parents/carers and agree to be bound by the Codes of Conduct and will respect all fellow netballers regardless of age, gender, ability race, cultural background, religious beliefs or sexual identity

Name of Young Person
Signature / Date:

PARTICIPATION/TRANSPORTATION/PHOTOGRAPHIC/VIDEO CONSENT

It is a requirement of Trafford Junior Netball Club policy that parental/legal guardian consent is provided for participation, transportation and photography. The Trafford Junior Netball Club Members’ Codes of Conduct and Safeguarding and Protecting Young People Policy are

available from Angela Nekooie in electronic form free of charge () or alternatively in paper form for which an administration charge of £10 will be payable. Please delete as appropriate where indicated by a * then sign and date at the bottom.

Participation: I agree to my son/daughter/child in my care taking part in the activities of the Club. In signing this form I confirm that I have received the Codes of Conduct of the Club for Athletes and Parents/carers which I accept and agree to.

Communication (For players aged 16 and over only): I agree/do not agree* that the team managers/coaches may contact my daughter/child in my care by group email or group text. Any individual email or text will be copied to me and the Club Safeguarding Officer.

Transportation: I consent/do not consent to my son/daughter/child in my care* 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 adult competition and tournaments, 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 sessions by officers of Trafford Junior Netball Club and/or their approved agents (which may include but is not limited to England Netball, GMCNA, GMJNL, MENL, Northern Thunder). Such images shall only be used for publicity/training purposes in accordance with the Trafford Junior Netball Club Safeguarding and Protecting Young People Policy and Photography Policy and I give/do not give consent for my son/daughter/child in my care* to feature in such photos/images. Where consent is given I hereby grant Trafford Junior Netball Club and their approved agents the right to use the images resulting from the photo/film shoots. This includes any reproductions or adaptations of the images for all general purposes, e.g. local newspapers, local magazines, other promotional articles (including flyers) and including internet web page content or other medial, which may include Twitter, or other social networking site and at anytime in relation to the work of Trafford Junior Netball Club and/or their approved agents and am aware that web sites can be viewed throughout the world, not just in the UK. If I become aware that these images are being used inappropriately I agree to inform Trafford Junior Netball Club immediately.

I______(parent/carer) *give consent / don’t give consent to Trafford Junior Netball Club and their approved agents to use the images resulting from photo/film shoots as mentioned above in relation to ______(young person’s name) and confirm that ______(young person’s name) is not subject to any Court Order prohibiting publication of their image.

Name of Parent/Carer
Signature / Date:

YOUNG PERSON

I ______(insert name of child / young person) *give consent/don’t give consent to Trafford Junior Netball Club and their approved agents to photograph or video my involvement in netball.

Name of Young Person
Signature / Date:

*DELETE AS APPROPRIATE

SPORTS INFORMATION/DEVELOPMENT

Young Person:-

Have you played Netball before? Yes ¨ No ¨

If yes, where have you played the sport and which are your favourite positions: (please indicate below)

Primary School / Goal Keeper
Secondary School / Goal Defence
Local Authority Coaching Sessions / Wing Defence
Club / Centre
County / Wing Attack
Other (Please Specify) / Goal Attack
Goal Shooter

Please list any other sports clubs you are a member of …………………………………………..

This information is optional :

What school/college or university do you attend?
U14 + Would you be interested in learning to coach and/or umpire? (Please state)

Parents/Carers

Would you be interested in learning to coach and/or umpire/or become an official? (Please state)
Would you be interested in being a team manager or act in an official capacity?(Please state)
What skills do you have that could help develop Trafford Junior Netball Club? (e.g. web design, accounting, printing) Please indicate if able/willing to offer any such skills.

PLEASE MAKE SURE PARENT/CARER HAS SIGNED THE FORM IN THE BOXES ON PAGES 2 & 3 AND THAT THE YOUNG PERSON HAS SIGNED IN THE BOXES ON PAGE 3 & 4 and that all relevant sections have been selected to confirm/refuse consents.

PLEASE RETURN THIS SIGNED FORM AND THE SIGNED AFFILIATION FORM TO YOUR TEAM MANAGER NO LATER THAN 20 AUGUST 2016