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YOUNG ADULT MEMBERSHIP APPLICATION FORM - 2023/24

Thank you for your interest in Chelmsford Hockey Club. You are invited to apply for membership by completing this form. Please ensure that all details are filled in where possible, as we are required by EHL, East and Essex rules to provide membership statistics by age group and sex.

* Required

MEMBER INFORMATION

First Name(s) *

Last Name *

Address Line 1 *

Address Line 2

Town

Postcode *

School/College (optional)

Gender

Date of Birth *

Place of Birth *

Home Phone

Mobile Phone

Email Address *

Club Member No.

If you know your Club Member No. (Shirt No.), please enter it below

Any volutary "off-pitch" skills?

e.g. DIY, coaching, fundraising, recruitment, photography, website development, accountancy etc

MEDICAL INFORMATION

Second Contact *

Second Contact Telephone *

Doctor's Name *

Doctor Telephone *

Doctor's Surgery *

Known Medical Conditions, Allergies, Medication *

Do not leave blank, please state none if so

FURTHER INFORMATION

Do you have a Coaching Qualification?

Give Details

Do you have an Umpire Qualification?

Give Details

Preferred Position?

Recommended By?

If a club member has recommended you to CHC please enter their name here

Committee Position

If you are interested in being considered for a committee position please enter it here

Clubs played for in the last 5 years:

Please enter your latest club first

Team Played for in Last Club?

e.g. First Team, Second Team etc

STORAGE & NEWSLETTER CONSENT

The options below are a legal requirement in our use of your data. Your consent for us to store your personal information is mandatory in becoming a member of Chelmsford Hockey Club. You will not be able to submit your membership form without it.

* Please tick this box to indicate that your are happy with us storing your information for the purposes of your membership with CHC.

Being added to our mailing list is, however, optional; this will not include communication from any third party, only newsletters from Chelmsford Hockey Club regarding our various hockey and social events held throughout the year.

Please tick this box to indicate that you would like to be added to the CHC mailing list (optional)