Membership Registration Form 2025/2026 Season Membership Payment Registration 2025/2026 Date Membership Type for 2025/2026 Season * Senior Membership Youth's (Under 18's) Family Membership (1 Senior & 2 Youth Members) Pavilion Membership Vets / CasualSenior MembershipClub Section * Ladies Player Mens PlayerWere you a member of Clontarf Hockey Club in 2024/25 season * Yes NoMembership Type * Senior Waged Member €350.00 Senior Unwaged Member €175.00 Full Time Student €175.00 Vets / Casual €125Membership Type * Pavilion €100.00Membership Type * Family (1 Senior + 2 Youths) €500 Additional Child - €100 per childAdditional Child - €100 Per Child Additional Child - €100 per child: 100,00 € Number of Additional Children Do You Require Insurance. Please note insurance is only valid 7 days after registration * Senior/Student/Vets/Casual Members (€25 per player) NoMembers need to notify the insurance company within 60 days of the event occurring in order to make a claim (not 60 days to make a claim, just to notify them)How Would You Like To Pay? * Online Payment Direct DebitDirect Debit Option Only Available For Senior Membership and Family Membership Standing Order Details Are As Follows: Account name: Clontarf Hockey Club Bank: AIB, 140 Lr Drumcondra Road, Dublin 9 Account Number: 09682003 Sort Code: 93-22-05 BIC: AIBKIE2D IBAN: IE25AIBK93220509682003Please make a note of the above bank details prior to submitting the registration form.Please include your name as the reference when filling out the standing order form for identification purposes.Total Membership Fee (Including Insurance if selected) SECTION A. SENIOR PLAYER & PAVILION DETAILSName * Name First Name First Name Last Name Last Name Date of Birth * Phone Number * Mobile or Landline Email Address * Emergency Contact Name * Emergency Contact Phone Number * Mobile or Landline Emergency Contact Relationship * Youth MembershipClub Section * Youth Girls Youth BoysWere you a member of Clontarf Hockey Club in 2024/25 season * Yes NoHave you already registered a Youth Member? Please only click 'Yes' if this is the second child you are paying for. There is a second child discount however, this does not apply for the first child. * Yes No What was the name of the previous registered Youth Member(s) * Membership Type * Youth (Playing Youth & Adult Hockey) €125.00 Youth (Only Playing Youth Hockey) €125.00If you have already registered a Youth Member you qualify for our additional Youth Member discount. Please select below the Youth Membership Type * Youth (Only Playing Youth Hockey) €100.00Total Membership Fee SECTION A.1 YOUTH PLAYER INFORMATIONChild's Name * Child's Name First Name First Name Last Name Last Name Child's Date of Birth * Club Section * Youth Girls Youth BoysEducation * Primary School Secondary SchoolChild's Class * Junior InfantsChild's Year * 1st Year 2nd Year 3rd Year 4th Year 5th Year 6th Year Parent/Guardians Full Name * Parent/Guardians Phone Number * Mobile or Landline Parent/Guardians Email * Parent/Guardian Relationship To Child * 2nd Parent/Guardians Full Name (If required) 2nd Parent/Guardians Phone Number (If required) Mobile or Landline 2nd Parent/Guardians Email (If required) 2nd Parent/Guardian Relationship To Child (If required) SECTION A.2 YOUTH PLAYER 2 INFORMATIONChild's Name * Child's Name First First Last Last Child's Date of Birth * Club Section * Youth Girls Youth BoysEducation 2nd Child Primary School Secondary SchoolChild's Class * Junior InfantsChild's Year * 1st Year 2nd Year 3rd Year 4th Year 5th Year 6th YearSECTION A.2 YOUTH PLAYER 3 INFORMATIONChild's Name * Child's Name First First Last Last Child's Date of Birth * Club Section * Youth Girls Youth BoysEducation 3rd Child * Primary School Secondary SchoolChild's Class * Junior InfantsChild's Year * 1st Year 2nd Year 3rd Year 4th Year 5th Year 6th Year2SECTION A.2 YOUTH PLAYER 4 INFORMATIONChild's Name * Child's Name First First Last Last Child's Date of Birth * Club Section * Youth Girls Youth BoysEducation 4th Child * Primary School Secondary SchoolChild's Class * Junior InfantsChild's Year * 1st Year 2nd Year 3rd Year 4th Year 5th Year 6th YearSECTION A.2 YOUTH PLAYER 5 INFORMATIONChild's Name * Child's Name First First Last Last Child's Date of Birth * Club Section * Youth Girls Youth BoysEducation 5th Child * Primary School Secondary SchoolChild's Class * Junior InfantsChild's Year * 1st Year 2nd Year 3rd Year 4th Year 5th Year 6th YearSECTION B. OTHER DETAILS Medical Disclosure (Allergies, Epilepsy, Diabetes, Heart Conditions, Special Needs etc) Please name players conditions if applicable Do you have any recommendations for a social event or fundraiser this year? Would you be interested in your child attending a Midterm/Summer Camp? Yes NoAll senior members are expected to volunteer as a coach or umpire throughout the season. This will be randomly assigned however we will do our best to give preference to those willing to coach or umpire more regularly.Are you willing to Coach/Umpire outside of your rostered sessions? Yes - Coaching Yes - UmpiringWould you be interested in taking an umpiring course? Yes NoWould you be interested in taking a coaching course? Yes No How would you like to help? Declaration & PaymentsPlease confirm the following I agree to photographs and/or videos being taken and the use of photographic and video material by Clontarf Hockey Club Please subscribe me to our club's newsletter & fixtures/results updatesAll players must register with Hockey IrelandClick here for Hockey Ireland Registration FormRegistration with Hockey Ireland * I have registered with Hockey IrelandDeclaration * I consent to having this website store my submitted information so Clontarf Hockey Club Committee can respond to my inquiry. I have read and agree to the Members Data Privacy PolicyMembers Data Privacy PolicyTotal Membership Fee (Including Insurance if selected) Amount Due Email Payment - Debit Card Only *SubmitStart Over If you are human, leave this field blank.
