2018 Senior Membership Application | Southern River Hockey Club

Senior Membership Application 2018

ATHLETE DETAILS*
First name Surname
Date of Birth*
Gender*
- Male
- Female
Address*
Street Address Suburb State Post Code
Home Phone
Mobile Phone*
Work Phone
Email*
Please enter these details carefully as this is the address that your confirmation email will be sent to.
Enter Email Confirm Email
Occupation
Membership Type*
Year last played in Hockey WA competition e.g. 2016*
Please list the last club you played for in Hockey WA competition during the last 3 years e.g. SRHC, Melville HC, etc*
Are you of Aboriginal or Torres Strait Islander origin?*
(This information is a requirement for Hockey Australia purposes only)
- Yes
- No
Are you a member with a disability?*
(This information is a requirement for Hockey Australia purposes only)
- Yes
- No
Please list any medical conditions or allergies*
Please provide details of any medical conditions or allergies that the Southern River Hockey Club need to be aware of. If no medical conditions, please type n/a in the box below.
EMERGENCY CONTACT DETAILS*
This is the person we need to contact in an Emergency situation
First name Surname
Best Contact Number*
SENIOR PLAYER COMMITMENTS - 2018*
UMPIRING
Throughout the season you will be allocated umpiring fixtures. If your team has a bye it is up to you, as part of your team, to help fulfil this duty. Failure to meet this commitment means your team will pay the fine incurred from the Association.
FUNDRAISING
In order to keep down the cost of playing fees and to pay for equipment, the Club runs a variety of fundraising activities. As a Club Member during the 2018 season you will be expected to participate in a number of fundraising activities over the year.
CLUB FUNCTIONS
Our committee works hard to organise Club functions. As a Club Member you will be expected to support the Club by attending as many functions as possible throughout the year.
NEWSLETTER
The newsletter, containing important information, articles and photos, is published regularly throughout the season and is available on the Club website.
CONDUCT
As a Club Member you will be expected to conduct yourself at all times in a fair and sportsman like manner, bringing credit to our Club. Failure to do so can result in you facing the Southern River Hockey Club Executive Committee and a possibility of your membership being terminated.
FEE PAYMENT
You are responsible for obtaining a receipt for fees paid. If you have not paid your fees in full or made direct debit arrangements with the Treasurer by the 30th April 2018 then you may find yourself ineligible for selection in a senior team until further notice. Failure to pay outstanding fees will deem you unfinancial with the club and, unless otherwise agreed upon in writing between you and the Executive Committee, you will be ineligible to play in any finals fixtures or receive any Club awards. Should you require a breakdown of the fees please ask the Treasurer.
UNIFORM
You agree to wear the complete playing uniform during a game consisting of Club playing shirt, the Club shorts/skort and Club socks. These can be purchased from the Club.
- I acknowledge that I have read and understood the Senior Player Commitments for 2018
PLAYER DECLARATION*
PLAYER RISK
I acknowledge that there are risks involved in playing hockey and agree to indemnify the Southern River Hockey Club and The Western Australian Hockey Association Inc. and/or their volunteers and employees and save them harmless and free from liability for any injury or loss suffered by me arising out of any activity involving me and the Club and/or the Western Australian Hockey Association Inc. I also confirm that I am physically and mentally capable to undertake hockey.
PLAYER INSURANCE
I acknowledge that the Southern River Hockey Club has taken out a Player Injury Insurance policy cover for me with the Hockey Australia National Group Insurance Plan managed by JLT Sport and placed with underwriter Sportscover Australia (full details available at www.hockeywa.org.au). This is a base cover only. This base cover can be topped up individually for any player at a very reasonable premium cost through Hockey WA’s website, which is highly recommended where private health cover and/or dental excess is not held. This top up of cover service is available interactively in one on-line session.
PRIVACY COLLECTION STATEMENT (HockeyNet Specific)
Hockey Australia (HA) requires the compulsory information requested for use in relation to HockeyNet. Any personal information provided will only be used in accordance with the objects and purposes of HA, HA general business and in relation to HockeyNet. If the requested personal information is not provided, you may not be able to receive the benefits of registration with the HockeyNet system. Individuals will be able to access their personal information through HA upon reasonable notice. For further information on Hockey Australia’s Privacy Policy refer to www.hockey.org.au.
UN-FINANCIAL PLAYERS
All senior fees due are to be paid in full/or a direct debit agreement signed by 30th April 2018 in order to remain financial. If no fees have been paid or direct debit arrangement made by this date you will be deemed “unfinancial” and will not be covered by player insurance. If you are having trouble paying your fees please contact the Treasurer to discuss a payment plan.
Any player that is deemed un-financial by the Treasurer will be ineligible to participate in ANY HWA senior fixtured game for 2018 (including but not limited to finals) and will also be ineligible for any end of season awards.
POLICIES AND PROCEDURES
The club-rooms and patio area at Sutherlands Park are a SMOKE FREE ZONE (as advised by the City of Gosnells and in accordance with Healthways). All members are asked to adhere and abide by this rule. Failure to do so may result in further action being taken by the Southern River Hockey Club Executive Committee.
Player misconduct such as abuse of umpires, other players or spectators that bring the club into disrepute will be treated seriously by the Southern River Hockey Club Executive Committee, which has the right to terminate your membership.
Any playing issues I may have, I agree to speak to my relevant playing representative.
You are required to read the Code of Conduct document and any other club policies that relate to your proposed membership before proceeding with this application. Click here to be taken directly to the Policies page of the website to view the relevant documents.
I acknowledge that I have read and understood the contents contained within the 2018 Senior Membership Application.
I acknowledge that I have read the Player/Athlete Code of Conduct, Spectator Code of Conduct and any other club policies and procedures available on the Club website that pertain to my membership application.
- I hereby submit my application for membership as indicated above and agree to abide by the Southern River Hockey Club Inc. Constitution, the Codes of Conduct and all rules and guidelines of the club as outlined in this application and published on the Club website
FEES*
All senior fees due are to be paid in full/or a direct debit agreement signed by 30th April 2018. For more information on payment arrangements please refer to the fees page on the website here.
When selecting your fee type below you are also acknowledging that you accept the clubs Refund Policy which is available for viewing here.
Please select the relevant fee rate from the drop down menu below. Note: Student ID will be required to obtain the Student Rates.
METHOD OF PAYMENT*
Please indicate how you will be paying your 2018 fees. Direct Deposits should be made to the SRHC Bank Account BSB 633-000 A/C 1479 41421. Please use the Payment ID and your surname in the reference field.
- Cash/Cheque/EFTPOS
- Direct Debit Agreement from my Bank Account
- Direct Deposit to SRHC Bank Account
Total
$ 0.00
Name
This field is for validation purposes and should be left unchanged.