SHU Women’s West District

Under 14 Parental Consent Form

The Parent or Guardian of any player under the age of 14 on 1st September 2016 should complete and return this form to the player’s club.

The club should photocopy the form and send the original to the SHU Women’s West District Treasurer along with the West District Subscription Form in October of each year (any additional forms after that date should be sent immediately on receipt from the parent); the photocopy should be retained by the club for club records.

PARENTAL SECTION

Club ________________________________________________________________

Player’s name _________________________________________________________

Date of Birth __________________________________________________________

Address ______________________________________________________________

	______________________________________ Post Code ________________

I consent to _____________________________ (Player’s name) playing in the SHU Women’s West District League and Cup competitions for a team of the above named club during the current season.

Signed ________________________________ Parent / Guardian (delete as required)

Print Name ___________________________________________________________

Address ______________________________________________________________

	_______________________________________ Post Code _______________

Contact Telephone Number ______________________________________________

Name of Alternative Contact _____________________________________________

Telephone Number of Alternative Contact __________________________________

Date ________________________________________________________________

CLUB SECTION

____________________________ Hockey Club confirms that __________________

(Player’s name) is registered as an Under 18 player with the SHU and is therefore covered by the SHU Insurance scheme.

Signature ______________________________ Print name _____________________

Position in club ________________________________   Date __________________