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* 1. Full name

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* 2. Contact details

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* 3. Date of birth (DD/MM/YY)

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* 4. Do you consider yourself to have a disability?

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* 5. Please detail any important medical information that the club should be aware of (e.g. disability, epilepsy, asthma, diabetes, etc.)

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* 6. Emergency contact details

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* 7. I agree to take part in the activities of the club. I also acknowledge that my details may be disclosed to third parties, insurance companies, Hockey bodies, under the terms of Streetly Hockey Club’s affiliation to the relevant governing bodies and sponsors and I agree to this. I also agree with the club's code of conduct & privacy policy and terms.

I also accept that the email address provided above will receive emails from Streetly Hockey Club regarding events & club updates.

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* 8. From time to time, publicity photographs may be taken that may include me and I agree with their taking and their publication.

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