JUNIOR ICONS REGISTRATION FORM 2009-2010
(To be completed by parent/guardian) Name of Participant: School: Home Address:
Post Code: Home telephone number including code: Are you willing to receive communication by email: Yes No
If yes please give active email address (one character including dots, underscores and hyphens to each
square please)
Age on 1 September 2009: Date of Birth:
Current School Year:
Emergency Contact (1) Name: ___________________. No : ____________________ Emergency Contact (2) Name: ___________________. No : ____________________ Please note: Please make sure your daughter is aware of who is collecting her. If your daughter decides to travel with someone who is not either a member of family or designated person they are to inform a member of the coaching staff. If they are not collected they are to inform a member of the coaching staff who will endeavour to contact one of their emergency numbers. My daughter may travel with _____________________________
Medical Details
Does the participant have a disability?
No Yes (If yes please give details)
Does the participant suffer from any allergies or illness or take any medication? E.g. asthma, diabetes, epilepsy. (If yes, please give details). Please list any other medical details that you feel we should know about.
No Yes : List of Medical Conditions: __________________________________
Note: Please ensure that your daughter has any medication that she may require with her at each training session. (E.g. inhalers, etc). All medication must be selfadministered. In the event of illness or injury I understand that all reasonable steps will be made to contact me. I consent that, in the event of illness/accident, any necessary emergency treatment can be administered including the use of anaesthetics.
No
Yes
DISCLAIMER
Applies to all ICONS Training Sessions, Matches, Tournaments and Activities I understand that Icons Netball Club or the organisation providing facilities, their agents or employees accept no responsibility for loss or damage incurred or injury sustained by or during attendance at any activity except where such loss, damage or injury can be shown to result directly from negligence of the said Organisation, agents, servants or employees.
Yes
Name [Printed (Parent / Guardian)] ______________________________________ Signed (Parent /Guardian)__________________________Date_______________
PHOTOGRAPHS (To be completed by Parent and Player) In accordance with our child protection policy we will not permit photographs, video or other images of young people to be taken without the consent of the parents/carers and children. The ICONS Netball Club will follow the guidance for the use of photographs a copy of which is available from Tina Surtees. The ICONS Netball Club will take all steps to ensure these images are used solely for the purposes they are intended. If you become aware that these images are being used inappropriately you should inform one of the ICONS Netball Club Committee Members immediately.
Parents Consent: I photographing or videoing my daughter:
consent to ICONS Netball Club
Childs Consent: I
consent to ICONS Netball Club
photographing or videoing my involvement in Netball.
Please tick this box if you do not wish your child/children to be photographed.
Please return to:
Tina Surtees Icons Secretary Thank you BE SURE TO ENCLOSE….. Signed Registration Form Signed Code of Conduct – Player Signed Code of Conduct – Parent Photo Consent Form