Register First Name Last Name Street Address City State NSW VIC Post Code Email Phone Gender Male Female Date of Birth Hockey ACT Number (if known) ~ Type '00' if unknown Highest level of outdoor Hockey you have played Season 2026 Division Selection Division 1 MenDivision 1 WomenDivision 2 MenDivision 2 WomenDivision 3 MenDivision 3 WomenMastersNon Playing - Social MemberUnder 10sUnder 12 BoysUnder 12 GirlsUnder 14 BoysUnder 14 GirlsUnder 16 BoysUnder 16 GirlsUnder 7s + Payment Terms Paid in full by Round 4 I agree to adhere to the payment terms selected above. Fees are as follows 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 Wodonga Hockey Club for the period of membership. Uniforms Agree Disagree I acknowledge that my uniform stays the property of Wodonga Hockey Club. 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 with Wodonga Hockey Club before? Yes No Photographs Agree Disagree I give permission for Photographs of myself/my child to appear on the Wodonga Hockey Club 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 Wodonga Hockey Club. All members & supporters of Wodonga Hockey Club shall conduct themselves in the spirit of good sportsmanship & show respect to teammates, officials & spectators at all time. Health Statement Do you suffer from Asthma? Yes No Do you suffer from Diabetes? Yes No Do you suffer from Epilepsy? Yes No Do you suffer from any allergies? Yes No Do you require any medication whilst playing Hockey? Yes No Do you have any other medical conditions that we should be aware of? Yes No Do you have ambulance cover? Yes No Emergency Contact Person Emergency Contact Address Emergency Contact Person Phone Consent for Medical Treatment Agree Disagree If deemed necessary, I authorise the Coach/Manager/Club person to consent to me/my child receiving emergency medical treatment and/or use of an ambulance as may be necessary. Consent for Medical Disclosure Agree Disagree I consent to my team manager/coach having the above health information. Volunteer Umpire Coach Manager Tech Bench EXPRESSION OF INTEREST: PLAYERS, PARENTS, SPECTATORS & other SUPPORTERS please tick many areas you may be interested in assisting, supporting or becoming involved in, with Wodonga Hockey Club. All players are to pack down at the end of the last game. How did you hear about us? Social Media School Google Friend Family Other Date Name/Signature Name & Validation of the applicant or guardian/parent (if the applicant is 18 years or under) Name: Signature* Your application is subject to approval by Wodonga Hockey Club committee. Submit