Registration Registration Form Email First Name * Last Name * Street Address City State NSW VIC Email Phone * Date of Birth Covid Vaccine * Double Dose 1st Dose Not vacinated Have you had your Covid Vaccine? (voluntary upload certificate - block out IHI number) Gender Male Female Other Hockey Victoria Number (if known) Highest level of Hockey (winter competition 2021) you have played * Team - Competition Selection JDK Management Competition -29th Sept 2021 - 16th Feb 2022 Premier (Mixed) Senior Men Senior Women Junior mixed (under 15) FEE'S * Agree Disagree Fees can be paid in person a week before to the 1st week of play - JDK Management Comp - $185 Premier & Senior | $125 Junior comp. Rules * Agree Disagree In the event of my/my child's admission as a member, I/my child agree to be bound by the rules of the Border Indoor Hockey for the period of membership.n Uniforms * Agree I acknowledge that my uniform stays the property of Border Indoor Hockey. A levy is included as part of my registration fees. I am required to return my uniform at the end of the season competition. Who is your winter club? Have you played Indoor with Border Indoor before? * Yes No Photographs * Agree Disagree I give permission for Photographs of myself/my child to appear on the www.borderindoorhockey.com website or in other forms of media releases & to include my name. Code of Conduct * Agree Disagree I/and or my child have read & understood & agree to abide by the "Code of Conduct" of Border Indoor Hockey. All members & supporters of Border Indoor Hockey shall conduct themselves in the spirit of good sportsmanship & show respect to teammates, officials & spectators at all time. Emergency Contact Person * Emergency Contact Person Phone * Indoor Help Umpire Coach Manager Set up Score the game EXPRESSION OF INTEREST: PLAYERS, PARENTS, SPECTATORS & other SUPPORTERS please tick many areas you may be interested in assisting, supporting or becoming involved in, with Border Indoor Hockey. Health Statement * Please disclose any chronic or recurrent ailments, allergy or a physical condition so that the correct information ca be provided to a health official in case of an emergency. Date * Name/Signature * Name & Validation of the applicant or guardian/parent (if the applicant is 16 years or under) Name: Signature* Your application is subject to approval by Border Indoor Hockey committee. Approval Your application is subject to approval by Border Indoor Hockey committee. Wodonga Hockey Club Inc. trading as Border Indoor Hockey Enter One Time Passcode HERE Please click Submit ~ then click Pay Now Registration Payment Pay Now Premier LeaguePosClubWLPTS1Hume75212Blazing Stump66193McDonalds67184JDK5616View full table Senior MenPosClubWLPTS1Livingstone120362Brereton67183Poppins57154Darmody2116View full table Senior WomenPosClubWLPTS1Flanagan93272Behrens94273Wolfe47134George2107View full table
