Senior Membership Registration 2019 2019-20 Senior Membership Player Name* First Last Phone Number*This number will be used as the primary contact for all communications from the club.Email Address* Address Street Address City County Gender*FemaleMaleDate of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Medical Conditions or AllergiesPlease specify if you/this child has any medical conditions (e.g. Asthma, dyspraxia etc.) that our coaches should be aware of.Previous Club?If this is the first time that you/your child is registering with the club, were you/they ever a member of another Irish Basketball Club?NoYesName of previous club*Please note that you may have to complete a player transfer form in order to join the club. This is available to download from the titans.ie/registration page.Terms & Conditions & Getting InvolvedData Protection Titans Basketball Club is committed to ensuring it meets the specific responsibilities set out in the Data Protection Act 2018. Members of Titans Basketball Club are also members of Basketball Ireland, the National Governing Body for Irish Basketball, and membership details are passed to Basketball Ireland. In order for the club to function, your personal details will, from time to time, be shared with other members in the club, i.e. the executive committee, registrar, managers, coaches etc. Members who play under the Galway and Regional Area Boards may have their names and dates of birth, and other personal details, given to these Area Boards. Personal Accident Insurance Titans Basketball Club does not provide Personal Accident Insurance for members. Parent/Guardian Declaration I am aware that Titans Basketball Club has developed a Child Safeguarding Statement and Risk Assessment and that the club is committed to ensuring the safety of my child by adopting the Basketball Ireland Code of Ethics for Children's Sport and having; Complaints and Disciplinary Procedures Club Children's Officers and a Designated Liaison Person Copies of all these policies, along with procedures for complaints and contact details of the Club Children's Officers and Designated Liaison Person are available on the club’s website www.titans.ie. I agree to my child to be photographed in line with this policy. Your child may be recorded during training and games as part of the team, and these recordings/photographs may be used on social media/website for promotional and/or for training materials. I understand that it is my duty to inform the Coaches of any important changes to my child’s health,medication or needs and also of any changes to our address or phone numbers given. In the event of illness, being the person having parental responsibility for the above named child/children, I give per If I cannot be contacted and my child should require emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency treatment or medication. I give my permission for information about my child's medical conditions/allergies to be shared with relevant responsible adults in the club (e.g. coaches, managers etc.) I agree to assist, where possible, with supervision of players and transport needs (giving lifts to games/tournaments etc) I will obtain Garda vetting for Titans and submit proof to the club. I am willing to allow my phone number to be circulated, on a list, to parents of members of Titans Basketball Club. I agree to receive communication via SMS (text), instant messaging services (e.g. WhatsApp) and email from the club. I agree to abide by the guidelines for parents and to make my child/children aware of the guidelines for young players in the Basketball Ireland Code of Ethics for Children's Sports - see https://bit.ly/30td455 I confirm that the details contained herein are correct to the best of my knowledge and that I have parental responsibility for the member applicant and give parental consent for my child to participate in and travel to all activities. Adult Player/Coach Declaration I agree to abide by the Basketball Ireland Code of Conduct/Code of Conduct for Coaches: http://sportlomo-userupload.s3.amazonaws.com/uploaded/galleries/638_uploaded/28c6e1eb13857ef0d72317cf265e10588aa3c4a7.pdf as is relevant (see www.basketballireland.ie for details) I am aware of Titans policies and procedures and agree to the terms set out in these policies (see www.titans.ie) I agree to be contacted by SMS, instant messaging services and email by Titans BC We are an entirely voluntary body, and as such, it's you, the members, who help us to thrive. Please tick one / all of the boxes in areas where you think you could help us.Volunteering I am willing to assist in supervising at the door / roll call I would like to get involved with coaching I would be willing to manage a team (send texts / organise kit etc) I would like to find out about becoming a referee I would like to find out about coaching courses I would like to find out how to become a table official NotesPlease provide any further information you think may be relevant - e.g. if registering additional adults / students and juvenile members.PaymentPlease Select Membership Type*Adult Player [€250]Juvenile u20 National League Player [€180]Full Time Student [€180]Unemployed Adult Player [€180]Wheelchair Player [€160]Family Rate [€350]Adult Recreational Player €5 per session PAYG [€40]Volunteer / Coach / Manager [€0]Non playing member [€20]Total Membership Fee 0,00 € Payment Method*If paying by cash, please contact *protected email* as soon as possible with payment as we cannot register you until payment has been received.CashCredit CardCredit Card* MasterCardVisaMaestro Card Number Expiration Date Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Security Code Cardholder Name Agreement to membership terms and conditions*Please type I AGREE to indicate that the details provided on the form are accurate, and that you agree to abiding by the terms and conditions as laid out above. 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