FREMANTLE HOCKEY CLUB
Stevens St Reserve
Fremantle WA 6160
PO Box 344
Melville WA 6956
SENIOR REGISTRATION FORM 2012
Personal Details (Please print clearly)
First Name(s)
Last Name
Mailing Address
Town/Suburb
Contact Details
Hm:
State
Postcode
Wk:
Mob:
@
Email: (Compulsory)
Date of Birth
/
/
Grade Played in 2011
Club Played for in 2011
Fulltime Student No.
Uni/School
New Player:
 No
 Yes
How did you hear about the FHC?
For Previous members, have any of your details changed since last season?
Yes / No
Have you completed any training courses in:
Coaching

Level Attained & Date Completed
_________________________________________
First Aid

Level Attained & Date Completed
_________________________________________
Additional Courses

Details
_________________________________________
Are you interested in helping the club with:
 Junior/Senior Coaching
 Fundraising
 Umpiring
 Team Manager
 Sponsorship
 Committee
 Other (Please provide details) __________________________________________________________________
SPONSORSHIP WANTED
Fremantle Hockey Club, which is a non-profit organisation that promotes hockey as a friendly sport, is
kept alive through the generous support of our sponsors. The Committee is keen to hear from any
prospective sponsors. There are many levels of sponsorship in the club’s structure – from Gold &
Naming Sponsors to Individual Players sponsors to in-kind sponsors.
Please contact a member of the Committee or make your interest known to your team captain/manager.
Don’t forget that Sponsorship dollars help to keep your fees down!
Fremantle Hockey Club
Postal Address: PO Box 344, Melville WA 6956
FREMANTLE HOCKEY CLUB
Stevens St Reserve
Fremantle WA 6160
PO Box 344
Melville WA 6956
FEE STRUCTURE 2012
We try as hard as possible to keep your playing fees low. Help us to do this by supporting the club through attending
fundraising functions, assisting in the running of the club where possible, sourcing sponsorship or spending your
money at the clubs facilities!
Early bird Special
Standard Fees
Pay by 01/05/12
Pay AFTER 01/05/12
Seniors Grass Grades
$325.00
$350.00
Full-time Students Grass Grades
$225.00*
$250.00
Seniors Turf Grades
$425. 00
$450.00
Full-time Students Turf Grades
$325.00*
$350.00
(Current Student Card to be shown at time of paying)
(Current Student Card to be shown at time of paying)
$350.00
Mid-Week Veterans
All members must pay annual fees according to the above fee schedule.
Should you have any difficulties in paying your fees and need to make arrangements to pay by instalments, please
contact the Club Treasurer, Ross Wharton-Street (Mobile: 0400 243 120) prior to the 1st May 2012.
Payments will be accepted as cheque, cash or credit card.
Please note credit card payments incur a 1% processing charge.
Fees
Turf Levy
$ _______ + $ ________ +
 Cash
 Cheque
 Visa
 Mastercard
 Eftpos
 Bankcard
Voluntary Contribution
$ ______________
+
Processing Charge
=
Total
$ ______________
=
$ ___________
   
Card expiry date:
______________________________
Name of Card Holder:
______________________________
Signature of Card Holder:
______________________________
I have read both the Fremantle Hockey Club Member’s Code of Conduct and the Fees Schedule above, understanding both my
conduct and payment obligations. During the season, I agree that if I cannot play in a fixture I will advise my Team Manager as soon as
possible and no later than the Thursday prior to that fixture.
I will make myself available for umpiring commitments, should these be necessary in my grade.
I am aware of the requirement to pay fees in full or contact the Treasurer to make payments by instalment by the dates agreed. I am
aware that failure to pay fees by the dates specified will delay complete registration and result in ineligibility to train a nd/or play until
rectified. By signing this form you agree to abide by the fees policy, available to view at www.freohockey.com
Signed: ______________________ Name: ____________________ Player/Parent/Guardian
Fremantle Hockey Club
Postal Address: PO Box 344, Melville WA 6956
FREMANTLE HOCKEY CLUB
Stevens St Reserve
Fremantle WA 6160
PO Box 344
Melville WA 6956
PREGNANCY POLICY (
AS APPROVED BY THE BOARD OF HOCKEY WA ON 9 MAY 2005, MINUTE NUMBER 05-0308)
The following policy is derived from advice provided by Minter Ellison Sports and Litigation Lawyers1:
Pregnant players are advised that continued playing during pregnancy exposes them and their unborn child to health
risks. Advice should be sought from an appropriately qualified medical practitioner about those risks and whether, or
for how long, it is safe to continue participating.
Australian Law imposes on a pregnant player a duty to take reasonable care to avoid foreseeable risks of injury to her
unborn child. If a player fails to do so, she runs the risk of being sued by her child later in life.
Players owe no greater duty of care to a pregnant player than they owe to any other player. Players are liable only for
those injuries that they cause by acting outside the rules of the game in a manner that is not ordinarily and reasonably
contemplated by other players.
The duty of care owed to an unborn child by another player is similar to that owed to the mother and all other players;
namely, to play by the rules in a manner that other players would ordinarily and reasonably expect.
Player Acknowledgement
I, (Print name) ______________________________________ a playing member of the Fremantle Hockey Club,
acknowledge that I have read and understood the Hockey WA policy on playing while pregnant.
I understand that it is my responsibility to seek advice from a qualified medical practitioner.
I understand that if I elect to continue playing, I do so entirely at my own risk.
I understand that other players are under no obligation to treat me differently to any other player.
I understand the care owed by me to my unborn child.
I understand that I have no claim for compensation against any player, Club or Hockey WA for any
injury to me or my unborn child caused during the course of any game, provided that the game is
played in accordance with the extant rules.
Player
Witness: ________________________________
(Print name)
Address:
Signed:
______________________________________
_______________________________________
______________________________________
_______________________________________
______________________________________
_______________________________________
Dated this ______________________ day of __________________ , 20 ____
(Day)
(Month)
(Year)
1Tony
O’Reilly and Dominic Villa writing in The SportVine, October 18, 2001
Fremantle Hockey Club
Postal Address: PO Box 344, Melville WA 6956