Crowborough Hockey Club Adult Membership Form 2023/2024
All current and prospective members of Crowborough Hockey Club (CHC) are required to complete this registration form. A Standing Order needs to be arranged before selection for the league season. All details will be kept in a secure database with access restricted to authorised club officers only.
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Email *
Section 1: Member Information
Player's Title (Mr/Mrs etc.) *
Player's Full Name *
Player's Date of Birth *
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Shirt Number (please type "N/A" if you do not yet have a shirt/shirt number assigned) *
Contact Email Address *
Full Home Address *
Home Phone Number *
Mobile Phone Number *
Membership Type *
Gender *
Section 2: Medical Information & Consent
In case of emergency and as part of the club's responsibility to its membership, ALL club members are required to complete this medical information form as accurately as possible. Details will be held securely with access restricted to authorised club officers only.
Next of Kin Full Name *
Next of Kin Relationship to Player *
Next of Kin Contact Number *
Doctor's Surgery Name *
Doctor's Surgery Address *
Doctor's Phone Number *
As far as you are aware, are you allergic to any medicines (if yes, please state)? *
Are you taking any regular medication (if yes, please state the medication and the reason for use)? *
Do you have any long-term illness, allergies or injuries (if yes, please state)? *
Section 3: Adult Member Consent
This information will be used to keep you informed about Club events and to contact you in the event of an accident or incident. Some of the information is required to comply with the England Hockey Equity Policy, which has been adopted by the Club. Your details will not be passed on to any other third-party organisations.
GDPR: I consent to CHC holding data on me in a club database and sharing that data with club officials for the purposes of club administration, and with Sussex and England Hockey. You have a right to see this data on request, and the right to have it deleted, if you choose, on leaving the club. I agree to CHC sharing my email address and other contact details with Sussex Hockey and England Hockey if required. Your details will not be passed to any other third party organisations. *
Insurance: The Club's Public Liability Insurance does not cover individual players, who participate at their own risk. The Club cannot be held liable for injuries sustained. However, the Club is providing LIMITED personal accident insurance within the membership cost. You may choose to arrange your own more enhanced cover. I have read, understood and accept the insurance which the club holds, details of which are located on the club website. *
Personal Protection: It is the responsibility of the player to ensure that the correct personal protection equipment is worn. The Club strongly recommends that a gum shield and shin pads are worn at all times. Additionally, box protection for males and facemask for everyone should be worn during short/penalty corners, but not limited to these activities. The Club is not responsible for injuries sustained whilst playing hockey. *
Photography: I give Crowborough Hockey Club consent to take photographs and/or videos of me. I give Crowborough Hockey Club full rights to use the images/videos resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group’s aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media such as Facebook and Instagram, press releases and funding applications. Such images shall only be used for club purposes in accordance with the Crowborough HC Safeguarding and Protecting Young People in Hockey Policy and Photography Policy.
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I hereby accept and acknowledge all of the above, including the Club Rules which are located on the website *
Required
Date form filled in *
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Declaration: I consider myself to be physically fit and capable of full participation and agree to notify the club of any changes to the medical information provided. Furthermore, in the event that I am injured I give my permission for the team managers/coaches appointed by Crowborough HC to obtain emergency medical treatment for on my behalf. *
Required
A copy of your responses will be emailed to the address you provided.
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