Office Use only

 

UL 

 

Villiers  

 

RENEWAL JUNIOR MEMBER FORM 2010/11

Name

 

D.O.B.

  

Must be 7 years of age to join

 

Name

 

D.O.B.

 

Must be 7 years of age to join

 

Additional Information

Address

 

Tel:

 

School

 

Mobile

 

Email

 

 

Membership Fee Per Family: (Please tick as appropriate).

 1.

€100-

Cash   

Cheque

 

 2.

€90 (100+90)

Cash

Cheque

 

 3.

€90- (100+90+90)

Cash

Cheque

 

* Membership must be paid by Sat 20th March 2010

 

Contact Name and No. in Case of Emergency

Name:

 

Tel: No.

 

Please Note:

All fees should be made payable to Limerick Hockey Club.

Also

·         It is a requirement that all colts wear the basic hockey protection equipment of

·         Gum Shield and Shin Pads. Also suitable clothes for rainy/cold days.

·         Please bring and collect children to/from the pitch as no responsibility can be taken

·          for children outside of the pitch or outside of session times.

·         Please tick the following box to indicate that you have read and give consent to

·          the following statement. I hereby give permission for any photographs taken of my

·          child during LHC competitions or training to be included in newspaper sports pages

·        

 
 
 and/or on the LHC web site.

·         I understand that Limerick HC is not responsible for any harm loss or damage caused

·          by my child/children participation while training or playing the sport of hockey, there

·          is no medical reason while my child/children cannot participate in the sport of hockey.

Signed……………………………………………..parent/guardian/carer

Coach Name:

 
 


Office Use Only