Club Membership Form 2010/11
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D.O.B. |
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Additional Information
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Address |
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Tel: |
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Work |
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Email |
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Membership Fee: (Please tick as appropriate).
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Senior Player |
190.00 |
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Student/Youth(14/23) |
130.00 |
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Please Note: All cheques should be made payable to Limerick Hockey Club. Subscription must be paid in full prior to
first league match. Please submit to club Treasurer Jennifer Joyce, 19 Ballycaseymore Hill, Shannon Co Clare
New Members
When did you last play hockey?
___________________________________________________
Which Club/School/University?
_______________________________Team________________
All Members
Preferred Position_________________________ 2nd
Choice Position______________________
Interprovincial/National Honours
_____________________________ Year_________________
Contact Name and No. in Case of Emergency
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Name: |
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Tel: No. |
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Also it is a requirement
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All players wear the basic hockey protection equipment of Gum Shield, Hockey Astro Turf Shoes and
Shin Pads.
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All players are required to volunteer to assist in junior coaching
and other events during the season.
By signing this form, I am acknowledging
the risks associated with playing hockey. I am aware that there is no club
insurance for players in place and I am responsible for my own insurance cover.
I agree not to make any claim against the club in the event of any injury
sustained by me while participating in hockey with the club.
Signed
Date
Players
under 18 must have form signed by a parent or guardian