Y4/5/6 Indoor Hockey Academy – Daynes Sports Centre – 7th Apr 2025

£45.00

Venue: Daynes Sports Centre
Date: 7th April 2025
Time: 10am-3pm
Years: Yr4-Yr5-Yr6

Children must bring gum shields, shin pads, lunch and water.

Please complete one form per child

Player’s name *

DOB *

School year *

year 4

year 5

year 6

Position *

Outfield

Emergency Contact 1 *

Emergency Contact 2 *

Medical informationPlease list all medical conditions the above child has, such as asthma, (and their inhaler type), epilepsy, diabetes and any allergies.

PhotographyWe occasionally use images of players for publicity purposes. If you do not give permission for photographs/video footage to be used by Empower Hockey please tick

No photos please

Terms and Conditions *I give permission for my child to take part in the Empower Hockey Camps and for the responsible individuals to take action on my behalf during those activities. I understand that every effort will be made to ensure the safety of my child during hockey activities and I undertake to adequately equip and clothe my child, with safety in mind (particularly the provision of appropriate clothes, trainers, long socks, shin and a gum-shield). I also understand that the organisers may exclude my child from the activities if they believe that their safety or the safety of others is being threatened. I agree that the coaches of Empower Hockey have my permission to take urgent decisions, including arranging necessary medical treatment, if my child is injured during the hockey camps although I understand that every effort will be made to contact me if such a situation arises. I understand that the information given on this form may be held on paper and computer files by officers of Empower Hockey but will only be used to ensure the safety of my child and other players, to provide information about hockey activities to me and my child and to assist in running and administering hockey activities. The personal information provided will not be given to others without my knowledge and I have the right to ask for these details to be amended or removed from Empower Hockey’s files at any time.

I agree

Category: Events

Y4/5/6 Indoor Hockey Academy – Daynes Sports Centre – 7th Apr 2025

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