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Gerrards Cross Hockey Club

Section 1: Member Contact Information
Section 2: Membership Type
Section 3: Member Information

Information in this section is optional and will be used for club development purposes only.

What school / college or university do you attend?
What is your occupation?
Would you be interested in being a manager or club officer? (Please state)
Would you be interested in learning to coach or umpire? (Please state)
What skills do you have that could help develop the club? E.g. Web design, accounting, printing, planning, sponsorship etc.
Section 4: Medical Information

In case of emergency and as part of the clubs responsibility to it's membership, ALL club members are required to complete this medical information form as accurately as possible.

As far as you are aware, are you allergic to any drugs?
Are you taking any regular medication? If so, for what reason?
Do you have any long term illnesses or injuries that team managers / coaches should be aware of e.g. diabetes, epilepsy, allergies.

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. I understand that in the event of any injury or illness, all reasonable steps will be taken to contact me and to deal with that injury/ illness as appropriate. Futhermore, in the event that I am injured I give my permission (for my son/daughter) for the team managers/ coaches appointed by GXHC to obtain emergency medical treatmeent on my behalf.

Section 5: England Hockey Ethnicity and Disability Information Requirements
Please tick to indicate any learning or physical disabilities

Please note that all of the club's policies, procedures and guidelines are available as a download from our website www.gxhc.co.uk

Section 6: Club Shirt Numbers

We need to keep a record of all the shirt numbers that club members are currently using in order to release numbers for future shirt issue. The shirt number I currently use is:

Section 7: Under 18 Member Consent (To be completed by Parent / Guardian)

It is a requirement of club policy that parental consent is provided for participation, trnasportation and photography. The GXHC members code of Conduct and Safeguarding and Protecting Young People in Hockey Policy are available on the club's website.

Indemnity: I agree to to indemnify Gerrards Cross Hockey Club and any registered manager / coach / trainer / helper / adult member against:-

  1. Any claim against the Club or Club member by a third party, directly or indirectly, arising out of any act or fault of my child.
  2. Any costs and expenses reasonably incurred and / or other sums disbursed by the Club or Club member on behlaf of my child during or as a result of being involved in any Gerrards Cross Hockey Club activity at any location.
  3. Any loss to the Club or Club member arising from danger to or loss of property or personal injury contributed to or caused by act or default of my child, provided that the indemnity shall not extend to any claim, damages, costs or expenses which may be indemnified under any policy of insurance.

I expect that all reasonable care will taken of my child and that whilst Gerrards Cross Hockey Club said members are in loco parentis they have my authority and will only be held liable in the event of gross or deliberate negligence being proved. I further accept that verbal instructions given to my child in the presence of a witness can constitute normal care and concern.

Transportation: I consent to my child travelling to venues for matches and training by transport provided by the club which may include travelling in other players' private cars.

Photography: In some environments, particularly adult competition, it is impossible to control photography by external parties, howevere, I am aware that there maybe times that photographs and/or footage maybe taken during matches and training by approved agents and/or officers of GXHC. Such images shall only be used for publicity/training purposes in accordance with the GXHC Safeguarding and Protecting Young People in Hockey Policy and Photography Policy and give consent for my child to feature in such photos / images. I hereby only grant 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 i.e. local newspapers, local magazines, other promotional articles (inc. flyers) and the club's website.