The following information is requested by England Netball to gain an understanding of who is participating in netball and to ensure equality of opportunity. Ethnicity (As defined by the 2011 Census) (Please tick as applicable) Prefer Not To Say Asian or Asian British - Indian White – British Asian or Asian British - Pakistani White – Irish Asian or Asian British - Bangladeshi White – Other White Background Asian or Asian British – Other Asian Background Mixed – White & Black Caribbean Asian or Asian British - Chinese Mixed – White & Black African Black or British – Caribbean Mixed – White & Asian Black or British – African Mixed – Other Mixed Background Black or British – Other Black Background Religion (Please tick as applicable) Disability (Please tick as applicable) Prefer Not To Say 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. Christian Buddhist Hindu Jewish Muslim Prefer Not To Say Sikh Blind or Visually Impaired Any Other Religion Deaf or Hard of Hearing Sexual Orientation (Please tick as applicable) Physical Impairment Learning Disability Prefer Not To Say Social or Behavioural Problems Heterosexual Mental Health Issues Gay Man Multiple Disabilities Gay Woman / Lesbian Any Other Impairment Bisexual Other Membership Fees Please pay the required fee specified in the table below by transfer to the club bank account. Name: Wallingford Netball Club Sort code: 30-99-03 Account Number: 01181456 Reference: Please use reference – “Aff – Player Name” e.g. “Aff – A Brown” If you are unable to transfer the money directly please provide a cheque made payable to “Wallingford Netball Club” with this form. Fees (please tick rate paying and method of payment): Membership rate Aged 18 or over Aged 16 or 17 (on 01-Sep-18) Online Cheque Cash Online Cheque Cash Standard rate £45 £35 Second family member rate * Rate only applies if aged 18 and over and in full-time education £35 £30 Summer taster rate Available from Apr 2019 to July 2019 only £25 £10 Second Claim (affiliated to another South region non-Oxon club) Please provide 1st claim affiliation number: £20 £15 * Valid providing player is a direct relative of the first affiliated player and resident at the same address Volunteering
Player Details Player name: Contact number *: Email address *: Home address: * Parent / guardian details if player is aged under 18 on 1 September 2018 Senior rates for monthly payments: over 18 years old as of 01-Sep-2018 Senior standard rate £14.00 per calendar month Second senior family member – must be in full-time education + £10.00 per calendar month Junior rates for monthly payments: under 18 years old as of 01-Sep-2018 (please tick one only) Under 18 years old standard rate £10.00 per calendar month Under 18 years old – 2nd family member + £8.00 per calendar month Under 18 years old – 3rd and subsequent family member + £6.00 per calendar month + Valid providing player is a direct relative of the first affiliated player and resident at the same address Terms and conditions I will set up a standing order for payment on the 1st of every month, starting 1 September 2018, to pay for player training subs, paying into the following account: Name: Wallingford Netball Club Sortcode: 30-99-03 Account number: 01181456 I will use the reference “Subs– Player Name” e.g. “Subs – J Bloggs” on the standing payment orders I make. I understand that this payment only covers training sessions and I am still required to pay cash subs for any matches that I play in. The monthly payments are calculated based on payment for 12 months of the year and take account: bank holidays, training breaks and an allowance for the unlikely event of cancelled sessions. A further reduction has been made as an incentive for paying by standing order. I understand that no money will be refunded in the unlikely event that sessions are cancelled by the club, or for sessions that I am unable to attend. There will be no refunds under any circumstances. I understand that if I cancel my standing order I must notify the club treasurer immediately. Wallingford Netball Club reserve the right to stop / remove people from the monthly training subs scheme with 1 month notice in writing without the need to provide a reason. Name* Signature* Date * Name and signature of parent / guardian / account holder if player is under 18 years of age Please return this form with the affiliation form above