Dartford Basketball Club Online Registration Form

All prospective members of Dartford Basketball Club are required to complete this registration form and return it with payment prior to selection for the league season. All details will be kept in a secure database with access restricted to authorised club officers only.

SECTION 1: MEMBER CONTACT INFORMATION

(This section should contain information about the player joining the club)

Title * -- Select Title -- Mr Mrs Miss Ms

Name *

Address 1 *

Address 2

Town *

Post Code *

Email address *

Confirm Email address *

Date Of Birth *

Contact Number *

SECTION 2: MEMBERSHIP TYPE

Membership Type * -- Select Membership Type -- Senior Mens Membership Senior Ladies Membership 10-18 Junior Membership

SECTION 3: MEMBER INFORMATION

(Information in this section is optional and will be used for club development purposes only)

STUDENTS - What school/college or university do you attend?

NON-STUDENTS - What is your occupation?

(When completing this form for a junior, please answer the following three fields as how the parent or guardian can help)

Would you be interested in learning to coach or umpire? (Please state)

Would you be interested in being a team manager or club officer? (Please state)

What skills do you have that could help develop the club? (E.g. web design, accounting, printing, planning, sponsorship)

SECTION 4: MEDICAL INFORMATION & CONSENT

(To be completed by parent or guardian if under 18)

In case of emergency and as part of the clubs responsibility to its membership, ALL club members are required to complete this medical information form as accurately as possible. Details will be held securely with access restricted to authorised club officers only.

Next Of Kin *

Relationship *

Contact Number *

Doctors Name

Surgery

Surgery Contact Number

As far as you are aware, are you allergic to any drugs? (Please state)

Are you taking any regular medication? If so, for what reason? (Please state)

Do you have any long term illnesses or injuries? (Please state)

SECTION 5: UNDER 18 MEMBER CONSENT (TO BE COMPLETED BY PARENT/GUARDIAN)

It is a requirement of club policy that parental consent is provided for participation, transportation and photography. Details on how your child is protected can be found in our Child Protection Policy.

SECTION 6: ETHNICITY & DISABILITY

Whilst it is not compulsory for the following sections to be completed, the paragraph below explains why this personal information is considered to be important.

Sport can and does play a major role in promoting the inclusion of all groups in society. However, inequalities have existed within sport particularly in relation to gender, race and disability. Sport England and England Basketball are committed to promoting and developing sports equity, which is about fairness in sport, equality of access, recognising inequalities and taking steps to address them. By monitoring the profile of people in sports clubs, national governing bodies of sport and Sport England can identify any issues relating to under representation of different groups and can develop strategies to ensure that all people have the opportunity in the future to develop and progress in sport.

England Basketball requests this data from clubs as part of the annual affiliation process and completing this data accurately enables the club to give an accurate picture to England Basketball on our membership.

Please select the option that best describes club members ethnicity

Please select the boxes to indicate any learning or physical disabilities

Please add any additional relevant information