Join Online - Seniors

Before completing this form please ensure you have read the Worthing Hockey Club Membership Terms and Conditions.

*** Under 18s should complete the Junior Membership form ***

Membership Rates (Subscription amounts include a Gift Aid voluntary contribution element – details on request):

Seniors U21
(in full time education)
Reduced **
£180
(£15 per month)
£60
(£5 per month)
£120
£10 per month)

** U21 (in employment), or other concession agreed with the committee

Standing order or online bank transfer: Lloyds Bank, Sort code 30-99-93, Account no. 02100987. Please put ‘SR – your name’ in the reference field.

Cheques payable to ‘Worthing Hockey Club’

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Gift Aid: If you are a UK taxpayer Worthing Hockey Club can benefit by recovering tax on donations. Your personal tax position is unaffected. Please consider if you can help support the Club in this way.

* – indicates mandatory field

Personal Details

Full Name *

Contact Email *

Date of Birth *

Address *

Contact Phone No. *

Emergency Contact Name *

Emergency Contact Phone No. *

Please state any coaching or umpiring qualifications held

Medical Information

In case of emergency, and as part of the Worthing Hockey Club responsibility to its membership, members are required to complete this medical information form as accurately as possible. Details will be held securely with access restricted to authorised officers only.

Please use this space to provide details of any medical information or disabilities that you feel should be brought to the attention of the managers and coaching staff.

* Medical Declaration: I consider I am physically fit and capable of full participation and agree to notify Worthing Hockey Club of any changes to the medical information provided. Furthermore, in the event of injury I give my permission for the team managers/coaches appointed by Worthing Hockey Club to obtain emergency medical treatment for me.

Payment

Membership Category (please select): *

Payment Method: *

I will set up a standing orderI will pay by bank transferI will post a chequeI will pay cash

* Declaration: I agree that I will participate in the club’s activities entirely at my own risk and that they must play in a manner that is safe for me and others. I have read and understood the rules of the Club and the Conditions of Membership and agree to abide by them. Worthing Hockey Club has adopted the EHB ‘Safeguarding & Protecting young people in Hockey’ and the ‘Code of Ethics & Behaviour’ policies. By signing the membership form you also agree to abide by these policies. These are available on the club website.

Gift Aid: If you are a UK taxpayer and would like to know more about how you could help the club through the Gift Aid scheme please check this box; you will then be sent more information and a simple form to complete.

Gift Aid

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Note: You will not be able to submit the form if you have unchecked any of the declaration boxes.