Pwc Hockey Academy Registration Form

PwC Hockey academy Registration Form Name of Child: 1. Date of Birth: Gender: M/F School: School Year: Name of Child:2. Date of Birth: Gender: M /F School: School Year: Name of Child:3. Date of Birth: Gender: M /F School: School Year:

Name of Parent(s) / Guardian(s): Parent’s E-Mail (this is our main avenue for correspondence, so please supply an address that is regularly monitored): ______Home Tel: Parent’s Mobile Telephone Number(s): Postal Address Post Code: Emergency Contact Names & Numbers (please offer 2 points of contact) 1. 2. I would like to attend Guernsey Hockey LBG Junior sessions (Please enter child’s name in box for session(s) to be attended):

PwC Junior Hockey academies: (Please circle age group) Tuesdays MF 5.30-7.00 p.m. Boys U12 / U14

Tuesdays FL 5.30-7.00 p.m. Girls U12/U14 Tuesdays MF 7.00-8.30 p.m. Boys U16 Thursdays FL 5.00 - 6.30p.m. Girls U16/ U18

Where Did You Hear about the Sessions? (E.g. through Year 5 & 6 taster sessions at school / a friend / poster at school etc)

Do you participate in any other sporting activity? Yes / No. If Yes, please list them

Medical Details:

Name of Doctor

Name of Surgery Tel:- Please state any known medical conditions that may affect your child(ren) during the session and your preferred course of action Are any special drugs or medical equipment required? If yes, please give details

PwC Hockey academy Registration Form

Is your child/Are your children allergic to any medication? If yes, please give details (including plasters).

I am aware that my child(ren) must wear shin pads and a gumshield to be allowed to participate in the session. I / We give permission for the above named child(ren) to attend the Hockey Sessions stated. I / We have read and will abide by the code of conduct (attached – to be retained by player). I/ We do/do not give permission for our child(ren) to be photographed for publicity purposes for Junior Hockey. Individual names will not be posted on the Guernsey Hockey website.

Signed (parent) Signed (child(ren))

Date Date

Parental Consent

This Section MUST be completed on behalf of all participants under 18 years of age Under current legislation regarding the protection and processing of personal data, certain information is classed by the law as ‘Sensitive Personal Data’. In order for the Guernsey Hockey LBG Junior Hockey Development Group to maintain records of participant’s who have taken part in a Guernsey Hockey LBG event, it is necessary for us to keep details of name, address, date of birth, contact details, disabilities and medical conditions.

To hold this ‘Sensitive Personal Data’ we will need your explicit consent. This can be given by completing the pro forma below.

The information will only be used for correspondence, monitoring and as management information. Information will be held in a database with access only available to Guernsey Hockey LBG Junior Hockey Development Personnel.

The information provided will not be passed on to any third parties.

I give explicit consent to the holding of information on the participant’s name, address, date of birth, contact details, disabilities and medical conditions for the purpose of monitoring, evaluation and advising future events only.

SIGNATURE ______

Please Print Name on this line ______

Parent □ Guardian □