WALLINGFORD NETBALL CLUB - CLUB MEMBERSHIP FORM 2015 -2016
JUNIORS (Under 16 years on 01-Sep-15)
WELCOME!
Dear Member
We are very pleased to welcome you / your child to our netball club.
To become an affiliated member of our netball club and England netball, we need to collect the
information listed in this form. This information is uploaded onto the England netball affiliation
database and is held by Wallingford Netball Club.
It is very important that all fields are completed so that you / your child can be affiliated to the club.
Once affiliated you / your child will be able to train and play for the club and are covered by the
relevant insurance policies.
Please ensure that you complete all fields on the form and that both the player and parent (or
guardian) sign and date at the end. We will require a hard copy of the signed form for our records.
It is also important that you provide up to date contact details so we can keep you informed of club
events. If your details change through the year, please let the Affiliation Secretaries or Coaches
know.
Some of the information requested byEngland Netball will be used to gain an understanding of who
is participating in netball and to ensure equality of opportunity. If you would prefer not to provide
what you may consider sensitive information, then please choose the “prefer not to state” option. If
you have any concerns regarding this, please do not hesitate to speak to the Affiliation Secretaries or
the Club Chair / Vice Chair.
We ask that in order to prevent injury, players ensure that all laces are fastened on trainers,
tracksuit bottoms are appropriate length and all hair is tied back off the face. Nails must be kept
short for training and matches/tournaments and all jewellery must be removed (exception of taped
wedding ring). It is not permitted to tape over earrings, even if they have only been recently pierced.
We hope that you / your child enjoy being a member of our club and look forward to your
participation.
With Kind Regards
Wallingford Netball Club Committee
http://www.wallingfordnetball.co.uk/
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WALLINGFORD NETBALL CLUB - CLUB MEMBERSHIP FORM 2015 -2016
JUNIORS (16 years and over as of 01-Sep-15)
PLAYER DETAILS
Surname:
Forenames:
Home Address:
Postcode:
Email:
Phone
Numbers:
H:
M:
Date of Birth:
DD/MM/YYYY
Gender: (Please
tick)
Male
Female
EMERGENCY CONTACT DETAILS
Surname:
Forenames:
Relationship:
Phone
Numbers:
H:
MEDICAL HISTORY
M:
Any known allergies / medical conditions / past injuries (please give details and dates)
Please continue overleaf if required
PARENT CONTACT DETAILS(for players aged 16 & 17 on 01-Sep-14)
Surname:
Forenames:
Home
Address:
Postcode:
Phone
Numbers:
Email:
H:
M:
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WALLINGFORD NETBALL CLUB - CLUB MEMBERSHIP FORM 2015 -2016
JUNIORS (16 years and over as of 01-Sep-15)
The following information is requested by England Netball to gain an understanding of who is participating in
netball and to ensure equality of opportunity. If you would prefer not to provide what you may considered
sensitive information, the please choose the “prefer not to state option.
Ethnicity (As defined by the 2011 Census)
(Please tick as applicable)
Prefer Not To Say
White – British
White – Irish
White – Other White Background
Mixed – White & Black Caribbean
Mixed – White & Black African
Mixed – White & Asian
Mixed – Other Mixed Background
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British – Other Asian Background
Asian or Asian British - Chinese
Black or British – Caribbean
Black or British – African
Black or British – Other Black Background
Religion
(Please tick as applicable)
Disability
(Please tick as applicable)
Prefer Not To Say
Christian
Buddhist
Hindu
Jewish
Muslim
Sikh
Any Other Religion
Do you consider yourself / your child to be disabled under
the Equality Act 2010? The Equality Act 2010 defines a
person as disabled as an individual that has a physical or
mental impairment that has a substantial and long-term
negative effect on their ability to carry out normal activities.
Prefer Not To Say
Blind or Visually Impaired
Deaf or Hard of Hearing
Physical Impairment
Learning Disability
Social or Behavioural Problems
Mental Health Issues
Multiple Disabilities
Any Other Impairment
Membership Fees
Please pay the required fee specified in the table below by transfer to the club bank account.
Name: Wallingford Netball Club
Sort code: 30-99-03
Account Number: 01181456
Reference: Please use reference – “Aff – Player Name” e.g. “Aff – A Brown”
If you are unable to transfer the money directly please provide a cheque made payable to
“Wallingford Netball Club” with this form.
Fees (please tick rate paying and method of payment):
Membership rate
Aged 18 or over
Online
Standard rate
Second Claim
Cheque
Cash
£35
£20
(affiliated to another South region non-Oxon club)
Please provide 1st claim affiliation number:
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WALLINGFORD NETBALL CLUB - CLUB MEMBERSHIP FORM 2015 -2016
JUNIORS (16 years and over as of 01-Sep-15)
Membership declaration
By returning this completed form I agree to take part in the activities of the club and abide by the
rules of the constitution. I also agree to abide by the laws of the game and England Netball’s rules,
regulations and disciplinary requirements.
As a parent / guardian am I am also providing consent for my child to participate.
 I have read and agreed to abide by the policies, codes of conducts, and emergency
procedures displayed on the website.
 I understand that I will be kept informed of activities associated with the club.
 I understand that in the event of any injury or illness all reasonable steps will be taken to
contact the named person as emergency contact.
 I give permission for photos to be taken by Wallingford Netball Club, and I’m happy for them
to be put onto the Wallingford Netball Club website and used for club purposes where
required.
 I am happy for my name to be included on the website where deemed necessary by the club
committee.
 I am happy for my telephone number to be added to your club listing to be circulated to all
members for ease of contact. Please note there will be a separate list for senior and junior
training / leagues.
DATA PROTECTION: AENA, your region(s), County(s) and Club will only use your personal data (including
potentially sensitive data) for the purpose of your participation in Netball, for regulatory reasons and to provide
you information about Netball. No data will be provided to Third Parties other than those detailed above.
AUTHORISATION SIGNATURE(S)
Name:
Signature:
Date:
Email:
Parent / Guardian
signature (U18’s only)
Please return completed and signed form to the Affiliation Secretaries or post to
61 Norries Drive, Wallingford, Oxfordshire, OX10 8JU
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WALLINGFORD NETBALL CLUB - CLUB MEMBERSHIP FORM 2015 -2016
JUNIORS (16 years and over as of 01-Sep-15)