Nottingham Outlaws

Recreational Ice Hockey Club

    Player Details form

    Please complete this form including any medical information that you feel is relevant to you playing ice hockey. Also include any information that would be helpful in the event of you being ill or having an accident during hockey training and games.

    Your Details

    Full Name*

    Date of Birth*

    Address*

    Postcode*

    Home Phone No.

    Mobile No.*

    Email

    1st Emergency Contact

    Name*

    Phone No.*

    Address
    (if different from above)

    Postcode

    2nd Emergency Contact

    Name

    Phone No.

    Address
    (if different from above)

    Postcode

    Medical Information

    Please indicate any relevant medical details (i.e. allergies, medication taken regularly, etc

    Any other information that you feel may be relevant or helpful

    ALL INFORMATION WILL BE TREATED IN THE STRICTEST OF CONFIDENCE AND WILL BE KEPT ON FILE FOR CLUB RECORDS ONLY