Memberships

Your Name

First

Last

Address

Address Line 1

City

State / Province / Region

Postal Code

England Membership Number

e.g 1234?

Mobile Phone

Home Phone

Email

Date Of Birth

Affiliation Type (Please select all that apply)

Player
Volunteer
Social
Official

Number Number Mobile

Disability

Do you consider yourself to be disabled under the Equality Act 2010? The Equality Act 2010 defines a person as disabled as an individual that has a physical or mental impairment that has a substantial and long-term negative effect on their ability to carry out normal activities. Select one of the following.

Medical Information

Please detail below any important medical information that our coaches/Junior Coordinator should be aware of (e.g., epilepsy, asthma, diabetes etc.)

Emergency Contact Name 1

First

Last

Please insert the information below to indicate the person(s) who should be contacted in event of an incident/accident.

Relationship to Member 1

Emergency Contact Number 1

Emergency Contact Details 2

First

Last

Please insert the information below to indicate the person(s) who should be contacted in event of an incident/accident.

Relationship to Member 2

Emergency Contact Number 2

Emergency Declaration

I understand that in the event of an emergency, we will immediately contact the emergency services to ensure timely and appropriate medical assistance. We will also attempt to contact the emergency contacts listed on the membership form. If we are unable to reach the designated emergency contacts and a decision regarding care needs to be made, we will defer to the advice and professional judgment of the attending emergency clinicians.

Emergency Contact Information Update

I certify that it is my responsibility to update the club when either medical information or contact information changes using the Change Member Details option on the home page of the website.

Affiliation Declaration

I certify that all the information is correct and agree to abide by England Netballs rules, regulations and disciplinary requirements.

Breakaways Netball Kit Declaration

I understand that dresses issued to me will remain the property of the club and must be returned should I leave the club. Failure to return these items within one month of leaving the club may result in me being invoiced for the full cost of replacing the item.

Photography / Film Declaration

I give consent to photographing, filming or videoing of myself involved in any activity undertaken as part of Breakaways Netball Club and photographs/videos being used on the club’s public and social media sites.
I DO NOT give consent to photographing, filming or videoing of myself involved in any activity undertaken as part of Breakaways Netball Club and photographs/videos being used on the club’s public and social media sites.

Select 1 of the above options. Breakaways netball is committed to the protection of children and vulnerable adults involved in sport. In accordance with our Child and Vulnerable Adults Protection Policy and Procedures, where possible we will not permit photographs, film, video or other images of children or vulnerable adults to be taken or used without the consent of the child/vulnerable adult and their parents/guardians or carers. Breakaways Netball will take all reasonable measures to ensure any images are used solely for the purposes for which they are intended. If you become aware these images are being used inappropriately you should inform the Club Child Protection Officer immediately.

GDPR Agreement

I consent to Breakaways Netball Club securely storing and processing my personal data in accordance with the UK General Data Protection Regulation (UK GDPR) and the club’s Privacy Policy. I understand that my data will only be used for purposes directly related to my membership and will not be shared with third parties without my explicit consent, except as required by law.

Acknowledgment of Policies

By completing this membership form, I agree to take part in the activities of the club, I confirm that I have read, understood, and agree to abide by all policies and procedures outlined by Breakaways Netball Club, including but not limited to the Emergency Declaration, Membership Terms, and Code of Conduct.

You can view the Policies here.

Junior Membership Form (U18)

Adult Membership Form (18 & Over)