Junior Membership 2021-2022

Please complete this application form to register your child for Southgate Juniors for this coming season.

If you are not currently a member, please do not complete this until you have received an invitation to join.

If you have more than one child playing, there is space at the bottom for Player2 and Player3.

Once you have completed the form, please follow the links to pay your membership fees.

If you have any queries, please contact juniors@southgatehc.org.uk

Please ensure you have read the Club Rules and Code of Conduct HERE before signing up for the season.

Junior Membership Form

Player1 First Name

Player1 Surname

Player1 Date of Birth dd/mm/yyyy

Player1 Gender

Player1 School

Player1 Relevant Medical History *

Player1 Email address if over 12 (optional)

Player1 mobile number if over 12 (optional)

Address1

Address2

Address3

Postcode

Parent1 first name and surname

Parent1 phone

Parent1 email address

Parent1 Occupation

Parent2 first name and surname

Parent2 email address

Parent2 phone

Parent2 occupation

Emergency contact & phone number

Communication Consent

Yes

Information and details about hockey activities, training times, matches etc are done by email and social media. Occasionally by post. I confirm I am happy to receive these messages.

Members Card Consent

Yes

A Southgate Hockey Centre Membership Card will be issued to each player which will entitle you to members rates at the bar. Child name, DOB, Parent name and parent email will be passed to the Centre Administration so cards can be issued. This information will be used for identification only

Photo Consent

Yes

From time to time we may take photographs of the children playing hockey. These are available to parents and children and may occasionally be used in promotional material. Please let us know if you have any concerns regarding this.

Risks of playing hockey

I understand

Hockey is a physical and demanding sport and as such there are inherent risks of injury and occasional injuries do occur. We recommend that you wear shin pads and a gum shield. The individual participants must take responsibility for themselves and other people. If you have a history of any medical impairment or do not regularly indulge in physically active sports, then you should seek medical advice before participating. If you suffer from any allergies, and particularly nut allergies, please let us know. Neither the club nor any individual can be held responsible for any injury or medical problem caused or aggravated by your participation in hockey

Code of Conduct *

Yes

I have read and understood Southgate Code of Conduct.

Player2 first name

Player2 Surname

Player2 DOB dd/mm/yyyy

Player2 Gender

Player2 Relevant Medical Information

Player2 School

Player2 Mobile Number (if over 12)

Player2 email address (if over 12)

Optional

Player3 First Name

Player3 Surname

Player3 Date of Birth dd/mm/yyyy

Player3 Gender

Player3 Relevant Medical Information

Player3 School

Player3 email address if over 12 (optional)

Player3 mobile number if over 12 (optional)