JUNIOR EXCELLENCE PROGRAMME
REGIONAL PERFORMANCE NETWORK
DEVELOPMENT SQUAD APPLICATION FORM
SEASON / 2014 - 2015
/
PERIOD / JAN - JUN /
FEES /
£87.50
PLAYER
PLAYER NAME
DATE OF BIRTH / SSRL MEMBER CLUB
PHONE/MOBILE / EMAIL ADDRESS
ADDRESS
POST CODE / GENDER (PLEASE TICK) / M / F
PARENT OR GUARDIAN
NAME
RELATIONSHIP
PHONE/MOBILE / EMAIL ADDRESS
ADDRESS
(IF DIFFERENT)
POST CODE
By ticking this box you are giving parental (or guardian) consent for the player to participate in the SSRL regional performance network development squad coaching programme.
Please tick this box if you do not wish to give consent for photographs or videos of your child to be used for coaching purposes or in promotional material, including media coverage.
By ticking this box you confirm this application and agree to abide by the regulations of the programme.
PAYMENT
Entry will not be accepted unless this Application and Full Payment is received in advance. Please note we will require your card details for payment. We will only require these details once. Details will be retained in a secure server hosted by our merchant services provider and will be used for all future events payments. SSRL uses Streamline for processing of debit and credit cards. Streamline is a Payment Card Industry Data Security Standard (PCI DSS Level 1) compliant debit and credit card processor. PCI-DSS provides mandatory security guidelines that assist merchants in preventing credit card fraud and identity theft all over the world.
Please provide a daytime contact number so that we can take your card details over the phone for the initial transaction.
Card holders daytime telephone number
By ticking this box you are authorising SSRL to take payment for the fees as advised from your credit/debit card.
Payment will be taken on receipt of this form.
EQUITY
Is the player registered as having a disability? /
YES /
NO
Is the player deaf/hearing impaired? /
YES
/
NO
Please indicate the player’s ethnic group
White /
Asian, Asian Scottish or Asian British
/
Black, Black Scottish or Black British /
Mixed and Any Other Background
Scottish /
Indian /
Caribbean /
Any mixed background
Other British /
Pakistani /
African
Irish / Bangladeshi /
Any other black background /
Any other background
other white background /
Chinese
Other Asian background
COACHING AND TRAINING
Please list any coaches with whom the player currently works
Please list any regular training sessions that the player currently attends
Any other relevant information
(e.g. previous or existing injuries, medical conditions, allergies and/or medications)
Scottish Squash and Racketball Ltd (SSRL) are fully committed to safeguarding the welfare of all children in its care. As part of this, we have a number of policies and guidelines in place, all of which have been established in recognition of our responsibility to promote safe practice and to protect children from harm, abuse and exploitation. The SSRL Child Protection Policy Statement can be found in full at:
http://www.scottishsquash.org/images/Scottish_Squash_and_Racketball/About_Us/Child_Protection/CPG-PR-001-A10_Child_Protection_Guidelines.pdf
All sessions conducted as part of the Regional Performance Network will be taken by coaches who have met the requirements of a SSRL approved coaching qualification. This requires them to abide by our Coaches Code of Conduct and Health and Safety Guidelines for Coaching. Full details of each of these policy documents can be found at:
http://www.scottishsquash.org/images/Scottish_Squash_and_Racketball/Coaching/Coaches_Code_of_Conduct.pdf
http://www.scottishsquash.org/images/Scottish_Squash_and_Racketball/Coaching/Health_and_Safety_Guidlines.pdf
All support staff operating on behalf of SSRL are bound by professional codes of conduct to ensure the confidentiality of information acquired in a professional capacity. Information will only be released to those within the multidisciplinary team who are directly involved with the care of the athlete. Only where specific consent has been given by the athlete will other medical or scientific professionals be consulted.
Players who join the Regional Performance Network must abide by the SSRL Code of Conduct and Fair Play Statement as detailed at http://www.scottishsquash.org/images/Code_of_Conduct__Fair_Play_Statement_for_members_-_revised_new_name_new_logo_17_08_2011.pdf
By returning this form and ticking the box above, you agree to accept all of the above and confirm each of the following:
· I have been made aware of the SSRL policies detailed above, and have read and fully understood these.
· I agree to inform the coach of any important changes to my child’s health, medication or needs, including injuries or risks that could potentially result in an injury.
· I agree to relevant details from reviews, assessments, treatments, consultations or testing undertaken by agencies working on behalf of SSRL (including area institutes of sport and private practitioners) being released to SSRL Performance Programme personnel.
This data may include written reports, videotape footage or personal communication.
· I understand that I should clarify with the specialists involved if there are any aspects that I don’t understand or need explained. I also understand that assessments and testing carried out are designed to identify any possible areas that need to be addressed in order to minimise risk of illness or injury during sporting activity as well as to optimise performance. I realise that it is not possible to remove those risks entirely and I agree that the professionals involved in the assessments accept no responsibility for any illness or injury.
· I confirm that all details are correct to the best of my knowledge at the time of writing and I agree to update any relevant parties (coach and/or SSRL representative) of any changes to the contact information provided in this form.
Please complete this form and return it to or by post to:
Stuart Crawford, Centre for Sport and Exercise, Heriot-Watt University, Edinburgh, EH14 4AS
For further details contact:
Stuart Crawford –
Entry logged by date of receipt in day book / M
SSRL Membership confirmed / M / If not, club & applicant advised: / M
Tick box checked and parental consent / M / If not, club & applicant advised: / M
Eligibility confirmed / M / If not, club & applicant advised: / E
Moved to approved folder / M
Credit/debit card payment approved / E/M
Receipt of valid entry confirmed to applicant / E
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