“Hockey, a Sport for Life”

Summer Hockey Camp 2015.

Information and Booking Form

The Hockey Camp promoted by the Rotherham Hockey Club in Partnership with Sheffield International Venues, runs from Monday 17th August to Wednesday 19th August 2015 inclusive.

If you are between the ages of 5 and 17 and interested in playing field hockey, then join us on our Summer Camp at

Westfield Sports College, Beighton.

Cost £15 per day or £40 if attending all 3 days.

For more information about the club please visit our website:

www.rotherhamhc.org.uk

PLAYER REGISTRATION / PARENTAL CONSENT FORM

Rotherham Hockey Club actively promotes a Child Protection and Welfare Policy. An integral part of this initiative relies upon parental co-operation and the provision of detailed information about our membership. Please help us to safeguard your child’s welfare by completing this form. This is a condition of membership.

Name:...... DOB:...... Shirt Number (if applicable)…….

Address:...... ……………………………………

...... Post Code:......

Tel. No: …………………………… E-Mail Address......

Second Emergency Telephone No:… ……………………………

Name and address of G.P:………………………………………………………………………………

School or College:……………………………………………… Male / Female …………..

If your child suffers from any illness or condition that you feel we need to be aware of, please give details below.

Please note this information will be treated in the strictest confidence and in the event of an injury, illness or at your child’s request we will make every effort to contact you immediately.

DECLARATION

I am pleased to allow my son or daughter to participate in field hockey fixtures, coaching and training sessions. I consider my son to be physically fit and capable of full participation, but in the event that he should be injured when I am not present, I give my permission for the team manager or coach appointed by Rotherham Hockey Club Limited, to obtain emergency medical treatment on his behalf, which may include the use of anaesthetics in hospital.

Does your son/daughter have any allergies? Please state below. YES / NO*
Does your son/daughter* need any regular medication or treatment? Please give details. YES / NO*
Does your child have a disability? Please state below YES / NO?
Visually impaired/hearing impaired/physical disability/learning disability/multiple disability. Please provide any further details you feel we should be aware of. YES / NO*
When was the last time that your son/daughter* was vaccinated against Tetanus?
I will inform the team manager of any changes to the details given above. YES / NO*
I consent to Rotherham Hockey Club processing and storing personal information for the purpose of administration and monitoring purposes. YES / NO*
I consent to Rotherham Hockey Club’s appointed representatives taking photos or videos of my son/daughter for promotional and coaching purposes only. YES / NO*
As part of our commitment to Equal Opportunities please state your ethnic origin below
White British/White Irish/White Other/Mixed – White and Black Caribbean/Mixed – White and Black African/Mixed – White and Asian/Mixed – Other/Asian or Asian British – Indian/ Asian or Asian British – Pakistani/Asian or Asian British – Bangladeshi/Asian or Asian British – Other/Black or Black British – Caribbean/Black or Black British – African/ Black or Black British – Other/Chinese/Other Ethnic Group/Prefer not to disclose
Signed: (Parent/Guardian*) Parent Date:
* Delete as appropriate.

BOOKING FORM

Please will you book my son or daughter on the Rotherham Hockey Club Summer Camp that takes place from the 17th August and 19th August 2015.

Full Camp 3 Days Inclusive. Cost £40

OR

Hockey Day Monday. Cost £15

Tuesday Cost £15

Hockey/Swimming Wednesday Cost £15

Total Payment £……………

Please tick the appropriate boxes.

Please return both the completed Booking and Parental Consent forms, together with your payment (Cheques made payable to Rotherham Hockey Club), to:

David Woodward, Youth Coordinator,

37 Great Bank Road, Rotherham S65 3BT.

Telephone 07774231206

E-mail

PLEASE, PLEASE, BOOK AS SOON AS POSSIBLE AND BEFORE 31st JULY SO THAT WE KNOW HOW MANY WE NEED TO CATER FOR. AFTER THIS DATE YOU WILL NEED TO CONTACT DAVID TO SEE IF THERE ARE ANY PLACES LEFT.