HCV Squads Nomination Form Senior 2013

HCV Squads Nomination Form Senior 2013

A very comprehensive event registration form, complete with waivers and terms & conditions Form Preview
  • Held the Long Weekend in June 8/9/10

    Men - Footscray

    Women - Geelong


    PROGRAMS INCLUDE THE FOLLOWING:

    Team Entry to Country Champs Tournament
    Trophies, Equipment and First Aid
    Coach Contribution

  • Team Nominating for:

  • Squads Medical and Consent Information

  • Health Care Information

  • Medical History

  • Note: the Association accepts no responsibility for the physical condition of the player.  The player should obtain appropriate medical advice and/or the approval of their medical practitioner prior to playing, particularly in circumstances where the player is aware of any pre-existing medical condition.

  • Player Code of Conduct

  • I agree to be bound by this Player Code of Conduct as follows:

    • I hereby undertake that during the course of traveling to, from and while attending any match or tournament I will behave in an appropriate and proper manner and will observe any rules or instructions given by the coach, manager, convener or member of the support team;
    • I will stay with the team at all times, unless accompanied by the coach, manager, convener or member of the support team;
    • I will not partake in non-prescription drugs at any time;
    • I will acknowledge that each individual and their property are to be valued and treated with respect;
    • I will not behave in a way which endangers, intimidates or interferes with the well-being of any other person or their property;

    I understand that if I fail to abide by this Code of Conduct that my parent/guardian will be notified and I may be escorted home at either my own or my parent/guardian’s expense

  • Waiver and Consent

  • I hereby agree to being a member of the HCV representative team and consent to traveling and participating in the matches or tournaments organized by Hockey Central Vic Inc.

    I consent to receiving any medical, dental and/or hospital treatment (should the need arise), and hereby authorise the coach, manager, convener or such other person officially associated with the team to seek the above treatment my behalf.

    I agree to indemnify and hold harmless Hockey Central Vic Inc., including its Committee of Management, employees and agents, coach, manager, convener and such other persons officially associated with the team, from all costs, losses and expenses incurred or arising out of the above medical, dental and/or hospital treatment administered for my benefit.

    "I the undersigned, having posed for, or having permitted my image to be featured in, a photograph or photographs or video or film taken by a photographer or video/film maker on behalf of HCV, hereby consent to the HCV or its assignees reproducing or using the said photograph or photographs or video or film or any part thereof in such form or manner as the HCV thinks fit."

  • Acknowledgement and Release

  • I hereby acknowledge and agree that I have read and understood the contents of this form and have completed this form in a truthful and accurate manner.  I release the Hockey Central Vic Inc. including its Committee of Management, employees and agents, coach, manager, convener and such other persons officially associated with the team, from any liability arising out of my failure to properly complete this form.

    By submitting this document, I acknowledge that this is proof of my agreement to the HCV Player Code of Conduct,  Waiver and Consent and Acknowledgement & Release and that all information provided is true and correct

  • Cost:     $70 per player

  • Payments: Post payment to Hockey Central Vic, PO Box 87, Golden Square, 3555 or

    direct debit in account

    Hockey Central Vic Inc.

    BSB 633000

    Account Number 145331625

    Reference SCC and your surname

  • If further information is required, please contact Lisa hcv.cvblazers@gmail.com

  • Should be Empty: