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* 1. Full name of under 18 member

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* 2. Contact details for member

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

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* 4. Is the member considered to have a disability?

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

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* 6. Emergency contact details (contact 1)

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* 7. Emergency contact details (contact 2)

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* 8. (For the member) 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 addresses provided above will receive emails from Streetly Hockey Club regarding events & club updates.

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* 9. (For the member) 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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* 10. I have permission from my parent/guardian for the submission of this membership form.

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