Membership type *

Youth

Social

Korinthians

Kobras

Official

Non-playing

Gender *

Male

Female

Name *

This is the child's name.

First Name

Last Name

Date of birth *

Note the format here - MONTH FIRST!

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preexisting medical conditions *

Does your child have any pre-existing medical conditions that may affect their participation in hockey?

No

Yes

Preexisting injuries *

Does your child have any existing injuries?

No

Yes

Allergies *

Does your child have any allergies?

No

Yes

Medical consent *

I consent to my child receiving medical treatment, including anaesthetic, which the medical professionals present consider necessary. (Please tick the box if agreed)

Yes

No

Transport consent *

I consent to my child being transported by persons representing the hockey club or one of its individual members for the purposes of taking part in hockey. I understand the hockey club will ask any person using a private vehicle to declare that they are properly licensed and insured and, in the case of a person who cannot so declare, will not permit that individual to transport children. (Select appropriate response)

Agree

Do not agree

Photo consent *

Your child may be photographed or filmed when participating in hockey events. All reasonable steps will be taken to obtain parental consent. In the absence of any explicit objection, those responsible will act in the best interests of the child which may include assuming parental agreement for the above reasons. Please indicate if you give your permission for your child to be involved in photographing/filming and for information about my child to be used for the purposes stated in Kinross Hockey Club’s Safe in Care Guidelines.

I give my permission

I do not give my permission

Supervision *

I acknowledge that the club is not responsible for providing adult supervision for my child except for formal junior hockey coaching, matches or competition.

Agreed

I do not agree