Clydesdale Western Junior Hockey Registration 2019/20
Email address *
Parent or Guardian's Name *
Your answer
Childs First Name *
Your answer
Childs Surname Name *
Your answer
Gender *
Required
Date of Birth *
MM/DD/YY
MM
/
DD
/
YYYY
School Year
Guardian's relationship to player *
Your answer
Guardian's Mobile Phone *
Your answer
Alternative Contact Name *
Your answer
Alternative Contact Contact Number *
Your answer
Alternative Contact Email Address *
Your answer
Which days is your child attending on? *
Required
If coming on a Friday which session is attended ?
Session 1 17-00 -1800
P5-6 18.00-19.000
P7-S1 19.00-20.00
S2-S6 20.00-21.00
Friday
Sunday Junior "Mini" Hockey Festivals
I would be interested in finding out about Sunday "Mini" Hockey Festivals
I consent to my child participating in organised hockey games for the Club in the 2019-2020 season *
Required
I accept the terms stated by Clydesdale Western Hockey Club as stated on the club's website and are to pay the appropriate fees. *
Required
I consent to my child receiving emergency medical treatment including anesthic as considered necessary by the medical staff present *
Required
I consent to my child being photographed, videoed or filmed during hockey training and games for the Club *
Required
I consent to my email address being used to communicate with the club. The club will promote club activities, products and events during the season. The Club's data retention policy is found here http://www.clydesdalehockey.org.uk/wp-content/uploads/2018/05/Privacy-Policy.pdf *
Required
Medical Details
Medical Allergies *
Required
Date of Last Tetanus Injection
MM
/
DD
/
YYYY
Does the child have a disability - If yes please give any relevant details
Your answer
If yes Please give details
Your answer
Child's Doctor *
Your answer
Childs Doctors Contact Phone Number *
Your answer
Childs Doctor's Address
Your answer
Contact Details
If you are a new member or you details have changed please complete the information below:
Address2
Your answer
Address3
Your answer
Address1
Your answer
Address4
Your answer
Post Code
Your answer
Home Phone
Your answer
Which School
A copy of your responses will be emailed to the address you provided.
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