Membership Payment – Wexford Hockey

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Membership Payment

Step 1 of 9

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Submission ID

Who is Completing the Registration Process?(Required)

How Many Players Are Being Registrered?(Required)

What Fee's Do You Wish to Pay?(Required)

Full Fee's / Half Fee's

Full Fee Membership Selections

Please select the quantity of memberships required per age group. Maximum of 4 Memberships Total.

Primary School Membership

Secondary School Membership

Third Level Education Membership

Adult Unwaged Membership

Adult Membership

Half Fee Membership Selections

Please select the quantity of memberships required per age group. Maximum of 4 Memberships Total.

Primary School Membership

Secondary School Membership

Third Level Education Membership

Adult Unwaged Membership

Adult Membership

Parents Information

Parents Name(Required)

Parents Phone No.(Required)

Parents Email(Required)

1st Players Details

Players Name(Required)

First Last

Players Date of Birth

MM slash DD slash YYYY

Player 1 Membership(Required)

Players Year in school as of September 2024(Required)

Players Mobile (enter 0000 if the player is in school)(Required)

Players Email(Required)

Players Address

Street Address Address Line 2 City County Eircode Country

1st Players Medical Information

Do you have any of the Following?

Asthma(Required)

Yes

No

Diabetes(Required)

Yes

No

Epilepsy(Required)

Yes

No

Fainting(Required)

Yes

No

Are there any medical condition(s) or allergies that we should be aware of?

If there is a likelihood that you will be bringing medication* to training/matches please provide details of this ( *no medication will be administered without detailed instructions)

1st Players Emergency Contact

Emergency Contact Name(Required)

Relations To Player(Required)

Emergency Contact Number (Mobile Only Please)(Required)

1st Players Consent

Consent(Required)

I consider myself to be in good health and capable of taking part in hockey. I have completed the medical details and consent that, in the event of any illness/accident, any necessary treatment can be administered to me, which may include the use of anaesthetics.

I understand and accept this statement(Required)

Consent(Required)

I understand that players MUST wear gum shields and shin pads for their own protection and safety. Whilst all Wexford Hockey Club coaches and helpers will take every precaution to ensure that sessions are run safely, they cannot be held responsible for any loss, damage or injury suffered to me. Players turning up to training without gum shields and shin pads play at their own risk.

I understand and accept this statement(Required)

I am aware that photographs and video recordings may occasionally be taken for use in publicity material and on our website/social media and I agree that images of me may be used in this way.(Required)

I am aware that photographs and video recordings may occasionally be taken for use in publicity material and on our website/social media and I agree that images of me may be used in this way.

Yes I consent

No I do not consent

Consent(Required)

Do you sign up to all elements of Wexford Hockey Club Code of Conduct

I agree to abide by the responsibilities of every member, to abide by the conduct expected of every player and club member, to abide by the personal pledges and to support and safeguard our younger players

Yes, I sign up to all elements of Wexford Hockey Club’s Code of Conduct(Required)

Do you consent to being added to any relevant WhatsApp Group(s) in relation to your involvement with Wexford Hockey Club? Please note: members can remove themselves from WhatsApp Groups at any stage(Required)

Do you consent to being added to any relevant WhatsApp Group(s) in relation to your involvement with Wexford Hockey Club? Please note: members can remove themselves from WhatsApp Groups at any stage

Yes I consent

No I do not consent

2nd Players Details

Players Name(Required)

First Last

Players Date of Birth

MM slash DD slash YYYY

Player 2 Membership(Required)

Players Year in school as of September 2024(Required)

Players Mobile(enter 0000 if the player is in school)(Required)

Players Email(Required)

Players Address

Street Address Address Line 2 City County Eircode Country

2nd Players Medical Information

Do you have any of the Following?

Asthma(Required)

Yes

No

Diabetes(Required)

Yes

No

Epilepsy(Required)

Yes

No

Fainting(Required)

Yes

No

Are there any medical condition(s) or allergies that we should be aware of?

If there is a likelihood that you will be bringing medication* to training/matches please provide details of this ( *no medication will be administered without detailed instructions)

2nd Players Emergency Contact

Emergency Contact Name(Required)

Relations To Player(Required)

Emergency Contact Number (Mobile Only Please)(Required)

2nd Players Consent

Consent(Required)

I consider myself to be in good health and capable of taking part in hockey. I have completed the medical details and consent that, in the event of any illness/accident, any necessary treatment can be administered to me, which may include the use of anaesthetics.

I understand and accept this statement(Required)

Consent(Required)

I understand that players MUST wear gum shields and shin pads for their own protection and safety. Whilst all Wexford Hockey Club coaches and helpers will take every precaution to ensure that sessions are run safely, they cannot be held responsible for any loss, damage or injury suffered to me. Players turning up to training without gum shields and shin pads play at their own risk.

I understand and accept this statement(Required)

I am aware that photographs and video recordings may occasionally be taken for use in publicity material and on our website/social media and I agree that images of me may be used in this way.(Required)

I am aware that photographs and video recordings may occasionally be taken for use in publicity material and on our website/social media and I agree that images of me may be used in this way.

Yes I consent

No I do not consent

Consent(Required)

Do you sign up to all elements of Wexford Hockey Club Code of Conduct

I agree to abide by the responsibilities of every member, to abide by the conduct expected of every player and club member, to abide by the personal pledges and to support and safeguard our younger players

Yes, I sign up to all elements of Wexford Hockey Club’s Code of Conduct(Required)

Do you consent to being added to any relevant WhatsApp Group(s) in relation to your involvement with Wexford Hockey Club? Please note: members can remove themselves from WhatsApp Groups at any stage(Required)

Do you consent to being added to any relevant WhatsApp Group(s) in relation to your involvement with Wexford Hockey Club? Please note: members can remove themselves from WhatsApp Groups at any stage

Yes I consent

No I do not consent

3rd Players Details

Players Name(Required)

First Last

Players Date of Birth

MM slash DD slash YYYY

Player 3 Membership(Required)

Players Year in school as of September 2024(Required)

Players Mobile (enter 0000 if the player is in school)(Required)

Players Email(Required)

Players Address

Street Address Address Line 2 City County Eircode Country

3rd Players Medical Information

Do you have any of the Following?

Asthma(Required)

Yes

No

Diabetes(Required)

Yes

No

Epilepsy(Required)

Yes

No

Fainting(Required)

Yes

No

Are there any medical condition(s) or allergies that we should be aware of?

If there is a likelihood that you will be bringing medication* to training/matches please provide details of this ( *no medication will be administered without detailed instructions)

3rd Players Emergency Contact

Emergency Contact Name(Required)

Emergency Contact Number (Mobile Only Please)(Required)

Relations To Player(Required)

3rd Players Consent

Consent(Required)

I consider myself to be in good health and capable of taking part in hockey. I have completed the medical details and consent that, in the event of any illness/accident, any necessary treatment can be administered to me, which may include the use of anaesthetics.

I understand and accept this statement(Required)

Consent(Required)

I understand that players MUST wear gum shields and shin pads for their own protection and safety. Whilst all Wexford Hockey Club coaches and helpers will take every precaution to ensure that sessions are run safely, they cannot be held responsible for any loss, damage or injury suffered to me. Players turning up to training without gum shields and shin pads play at their own risk.

I understand and accept this statement(Required)

I am aware that photographs and video recordings may occasionally be taken for use in publicity material and on our website/social media and I agree that images of me may be used in this way.(Required)

I am aware that photographs and video recordings may occasionally be taken for use in publicity material and on our website/social media and I agree that images of me may be used in this way.

Yes I consent

No I do not consent

Consent(Required)

Do you sign up to all elements of Wexford Hockey Club Code of Conduct

I agree to abide by the responsibilities of every member, to abide by the conduct expected of every player and club member, to abide by the personal pledges and to support and safeguard our younger players

Yes, I sign up to all elements of Wexford Hockey Club’s Code of Conduct(Required)

Do you consent to being added to any relevant WhatsApp Group(s) in relation to your involvement with Wexford Hockey Club? Please note: members can remove themselves from WhatsApp Groups at any stage(Required)

Do you consent to being added to any relevant WhatsApp Group(s) in relation to your involvement with Wexford Hockey Club? Please note: members can remove themselves from WhatsApp Groups at any stage

Yes I consent

No I do not consent

4th Players Details

Players Name(Required)

First Last

Players Date of Birth

MM slash DD slash YYYY

Player 4 Membership(Required)

Players Year in school as of September 2024(Required)

Players Mobile (enter 0000 if the player is in school)(Required)

Players Email(Required)

Players Address

Street Address Address Line 2 City County Eircode Country

4th Players Medical Information

Do you have any of the Following?

Asthma(Required)

Yes

No

Diabetes(Required)

Yes

No

Epilepsy(Required)

Yes

No

Fainting(Required)

Yes

No

Are there any medical condition(s) or allergies that we should be aware of?

If there is a likelihood that you will be bringing medication* to training/matches please provide details of this ( *no medication will be administered without detailed instructions)

4th Players Emergency Contact

Emergency Contact Name(Required)

Emergency Contact Number (Mobile Only Please)(Required)

Relations To Player(Required)

4thPlayers Consent

Consent(Required)

I consider myself to be in good health and capable of taking part in hockey. I have completed the medical details and consent that, in the event of any illness/accident, any necessary treatment can be administered to me, which may include the use of anaesthetics.

I understand and accept this statement(Required)

Consent(Required)

I understand that players MUST wear gum shields and shin pads for their own protection and safety. Whilst all Wexford Hockey Club coaches and helpers will take every precaution to ensure that sessions are run safely, they cannot be held responsible for any loss, damage or injury suffered to me. Players turning up to training without gum shields and shin pads play at their own risk.

I understand and accept this statement(Required)

I am aware that photographs and video recordings may occasionally be taken for use in publicity material and on our website/social media and I agree that images of me may be used in this way.(Required)

I am aware that photographs and video recordings may occasionally be taken for use in publicity material and on our website/social media and I agree that images of me may be used in this way.

Yes I consent

No I do not consent

Consent(Required)

Do you sign up to all elements of Wexford Hockey Club Code of Conduct

I agree to abide by the responsibilities of every member, to abide by the conduct expected of every player and club member, to abide by the personal pledges and to support and safeguard our younger players

Yes, I sign up to all elements of Wexford Hockey Club’s Code of Conduct(Required)

Do you consent to being added to any relevant WhatsApp Group(s) in relation to your involvement with Wexford Hockey Club? Please note: members can remove themselves from WhatsApp Groups at any stage(Required)

Do you consent to being added to any relevant WhatsApp Group(s) in relation to your involvement with Wexford Hockey Club? Please note: members can remove themselves from WhatsApp Groups at any stage

Yes I consent

No I do not consent

2 Full Membership Discount

Price:

2 Half Membership Discount

Price:

3 Full Membership Discount

Price:

3 Half Membership Discount

Price:

4 Full Membership Discount

Price:

4 Half Membership Discount

Price:

Total

Email(Required)

Credit Card

Firing the spirit of fairplay & hockey

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wexfordhockey@gmail.com
Ballynagee, Co. Wexford, Y35 WY28

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