REGISTRATION | Clontarf Hockey Club

Date

Membership & Insurance Details

Club Section *

Ladies

Mens

Youth Girls

Youth Boys

Were you a member of Clontarf Hockey Club in 2019/20 season *

Yes

No

Membership Type *

Have you already registered a Youth Member? *

Yes

No

Due to current Irish Hockey Return to Play Protocol, for all away matches, a player's name and telephone number must be shared with the away club. By ticking the yes box you agree for us to share your name and telephone number. If you select no, you will not be able to be selected for away matches while this current rule is in place. This rule is subject to change and members will be informed if that is the case. *

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) €125.00

If you have already registered a Youth Member you qualify for our additional Youth Member discount. Please select below the Youth Membership Type

Youth (Playing Youth & Adult Hockey) €100.00

Youth (Only Playing Youth Hockey) €100.00

Do You Require Insurance. Please note insurance is only valid 7 days after registration *

Senior/Student/Vets Member (€25 per player)

No

Do You Require Insurance. Please note insurance is only valid 7 days after registration *

Junior Member (€15 per player)

No

How Would You Like To Pay? *

Online Payment

Direct Debit

Standing Order Details Are As Follows:
Account name: Clontarf Hockey Club
Bank: AIB, 140 Lr Drumcondra Road, Dublin 9
Account Number: 09682359
Sort Code: 93-22-05
BIC: AIBKIE2D
IBAN: IE25AIBK93220509682359

Please make a note of the above bank details prior to submitting 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. PLAYER INFORMATION

First Name *

Surname *

Date of Birth *

Phone Number *

Mobile or Landline

Email Address *

Emergency Contact Name *

Emergency Contact Phone Number *

Mobile or Landline

Emergency Contact Relationship *

SECTION A.1 JUNIOR PLAYER INFORMATION

Child's First Name *

Child's Surname *

Child's Gender *

Male

Female

Child's Date of Birth *

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 B. OTHER

Medical Disclosure (Allergies, Epilepsy, Diabetes, Heart Conditions, Special Needs etc)

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

No

All 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 - Umpiring

Would you be interested in taking an umpiring course?

Yes

No

Would you be interetsed in taking a coaching course?

Yes

No

How would you like to help?

Please 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 updates

Declaration *

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 Policy

Total Membership Fee (Including Insurance if selected)

Amount Due

Payment - Debit/Credit Card *

Members Data Privacy Policy

Membership Registration Form

Membership & Insurance Details

SECTION A. PLAYER INFORMATION

SECTION A.1 JUNIOR PLAYER INFORMATION

SECTION B. OTHER