Senior BHC Membership Application Form | 8 Month Payment Plan


BELLVILLE HOCKEY CLUB
C/O VOORTREKKER & LANDDROS ROADS, BELLVILLE
www.bellvillehockey.com
Email address: admin@bellvillehockey.com

 

In terms of Clause 7 of the BHC constitution, I ( ) hereby apply for membership of the Bellville Hockey Club. If accepted, I ( ) hereby undertake to pay the annual membership fee, and to familiarize myself with, and abide by all club rules as well as the club constitution. I ( ) also wish to register as a hockey player in a team affiliated to the Bellville Hockey Club, and undertake to pay the affiliation fee, as set out below, and commit myself for the full season, attend practices & matches. I ( ) acknowledge that I may be dropped should I fail to attend practices without providing an acceptable explanation. I ( ) will familiarise myself with and adhere to the BHC & WPHU Code of Conduct.

 

FULL NAME:

  

GENDER:

  

ID NUMBER:

  

SAHA NUMBER:

  

 

EMPLOYMENT STATUS:

  

COMPANY:

  

OCCUPATION: 

  

PHYSICAL ADDRESS:

  

   

   

   

   

   

CONTACT NUMBER:

  

EMAIL ADDRESS:

  

PREVIOUS CLUB:

  

CLEARANCE LETTER:

  

ABLE TO UMPIRE:

  

UMPIRE LEVEL:

  

If "Clearance Letter" is answered yes, I ( ) will email my clearance letter to admin@bellvillehockey.com, prior to the first game of the season.

 

By signing this application form:

  • I ( ) acknowledge that my Senior Club Membership Fee of (R415.00 / month for 8 months) will be paid in full by the end of the 2024 season.
  • I ( ) acknowledge that the use of the facilities offered by Bellville Hockey Club shall be at my own risk, and I hereby indemnify the Bellville Hockey Club against all loss, damage, injuries, costs, charges and expenses which I may sustain or incur arising out of, or attributable to me utilizing these facilities.
  • Should I ( ) be in arrears from previous years, I acknowledge that I will not be allowed to attend practices, nor be considered for selection for matches, and that all arrears, including the admin fee, must be settled in full, before I am eligible to play.
  • I ( ) agree to pay the annual membership fee plus the hockey registration fee on or before the 31 May 2024.
  • I ( ) agree to pay the balance of the membership fee and registration fee in full by 31 December 2024, in equal monthly instalments from May 2024, or I accept that I will forfeit my playing rights for the second half of the season.
  • Should I ( ) be unable to pay the outstanding membership fee in full by the end of my aforementioned payment plan duration, I must bring this to the attention of my team coach and the BHC executive, who may allow me to enter into a payment plan, (forms available from Treasurer). I agree to pay an R25 administrative fee per month, in addition to the membership and full affiliation fee, until settled in full, notwithstanding that the full amount must settled by no later than the 31 December 2024, failing which I will forfeit my playing rights.
  • I ( ) acknowledge that I may not move to, or play for any other club affiliated to WPHU, SAHU or FIH until such time as all outstanding debts with Bellville Hockey Club have been settled in full and I have been issued with a clearance letter.
  • I ( ) understand that I remain responsible for payment in full of the hockey affiliation fees, regardless of any circumstances arising due to injury or any other matter which prevents me from completing the 2024 season.

 

Leave this empty:

Signature arrow sign here

Signed by Ryan Wallace (Club Chairman)
Signed On: April 17, 2024


Signature Certificate
Document name: Senior BHC Membership Application Form | 8 Month Payment Plan
lock iconUnique Document ID: b41f5c5ade1563d0f10e07cce0bace5e400cdfd6
Timestamp Audit
March 24, 2022 4:46 pm SASTSenior BHC Membership Application Form | 8 Month Payment Plan Uploaded by Ryan Wallace (Club Chairman) - info@bellvillehockey.com IP 41.116.209.101
April 2, 2022 2:27 am SAST Brent Swart - chairman@bellvillehockey.com added by Brent Swart (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 41.71.60.140
April 2, 2022 3:06 am SAST Brent Swart - chairman@bellvillehockey.com added by Brent Swart (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 41.71.60.140
April 2, 2022 3:06 am SASTBryce West - admin@bellvillehockey.com added by Brent Swart (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 41.71.60.140
June 13, 2022 1:20 pm SAST Brent Swart - chairman@bellvillehockey.com added by Brent Swart (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 197.155.10.89, 41.185.29.210
June 13, 2022 1:20 pm SASTBryce West - admin@bellvillehockey.com added by Brent Swart (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 197.155.10.89, 41.185.29.210
April 10, 2023 7:17 pm SAST Brent Swart - chairman@bellvillehockey.com added by Brent Swart (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 197.155.25.7
April 10, 2023 7:17 pm SASTBryce West - admin@bellvillehockey.com added by Brent Swart (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 197.155.25.7
April 10, 2023 8:04 pm SAST Brent Swart - chairman@bellvillehockey.com added by Brent Swart (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 197.155.25.7
April 10, 2023 8:04 pm SASTBryce West - admin@bellvillehockey.com added by Brent Swart (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 197.155.25.7
March 29, 2024 5:30 pm SAST Brent Swart - chairman@bellvillehockey.com added by Ryan Wallace (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 41.116.133.204
March 29, 2024 5:30 pm SASTBryce West - admin@bellvillehockey.com added by Ryan Wallace (Club Chairman) - info@bellvillehockey.com as a CC'd Recipient Ip: 41.116.133.204
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https://www.bellville.hockey/
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