La Trobe University Hockey Club Membership Form
Welcome to the La Trobe University Hockey Club for 2020.

The club treats this information with respect and confidentiality.
PLAYER INFORMATION
Member Type *
Surname *
First Name *
Preferred Name
If different from above.
Date of Birth (DD/MM/YY) *
Gender *
CONTACT INFORMATION
If you are a parent completing this for a Junior, please complete this section with YOUR details.
Email Address *
Mobile Number *
Address *
Suburb *
Post Code *
Do you live in Darebin? *
PLAYER BACKGROUND
Study/Occupation *
Please tick the following where applicable
If you ticked 'Current La Trobe Student' please provide your student number
Including 2020, how many seasons have you played at La Trobe University Hockey Club? *
Include this year in your total. For example, if 2020 is your first season, enter '1'. If 2020 will be your fifth year, enter '5'. Please be as accurate as possible, the Club uses this information to assist with record keeping such as Long Service awards.
If this is your first season at the club - how did you hear about us? *
If you selected 'Friend or family' above, please provide their name?
Referrers are rewarded as part of our Referral Program. Payment made upon successful referral of Senior Players only once fees are paid, and can only be referred by current members who are financial.
Will you require a transfer from another Victorian club? *
Do you have any of the following current qualifications?
Would you be interested in coaching Juniors or Metro teams? *
Do you have a Working with Children Check? *
Do you have a Responsible Service of Alcohol (RSA)? *
If you are a current La Trobe Student, would you be interested in playing University Games? *
EMERGENCY CONTACT
If you are a parent completing this for a Junior, please provide an emergency contact other than yourself.
Full Name *
Contact Number *
Relationship *
MEDICAL CONDITIONS
If you have any medical conditions that may impact your ability to play hockey, please notify your Captain to assist in treatment if necessary.
UMPIRING
All members playing Seniors who are 18+ are expected to assist the Club from time to time, like running the BBQ and volunteers for other events. This includes umpiring at least one game throughout the season.

If you prefer not to umpire, you can avoid being rostered by paying a $60 levy prior to Round 1 (this will help cover the cost of your replacement). If you choose not to pay, or are late in doing so, you will be placed on the roster and it will be your responsibility to find a replacement. We encourage all members to attempt umpiring at least one.

If a player is rostered and fails to turn up, they must covering the costs of a replacement, and will be re-rostered.
Would you like to appear on the Umpiring Roster this year? *
Are you interested in appearing on the internal Club Umpire List? If yes, we will contact you throughout the year asking if you would like to cover games. Payment ranges from $30 to $50 per game depending on location. *
AGREEMENTS
Do you agree to abide by the La Trobe University Hockey Club Code of Conduct and other policies? *
Required
Do you understand that any unpaid fees may result in penalties? *
Required
Do you understand that you are not covered by insurance unless fees have been paid in full? *
Required
Do you understand that you are not covered for ambulance under hockey insurance? *
Required
Do you agree to be put on the La Trobe University Hockey Club email list? *
Required
Do you agree to allow La Trobe University Hockey Club to use your photo for external marketing material? *
Required
By ticking the following box, you agree the information provided is accurate to the best of your knowledge. *
Required
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