IWCB 2014 YOUTH COUNTY TEAMS NOMINATION FORMS

(One form per player with all sections completed clearly)

Players Name: Gender: Male / Female

Contact Details

(Home Tel): (Parent Mobile):

Email Address:

Home Address:

Trial & Age Group Details:

DOB:

Age Group (please circle): U10 U11 U12 U13 U14 U15 U17

(e.g. an under 10 must be under 10 yrs of age at midnight on the 31st August 2013)

Any Existing Injury’s:

School: Cricket Club:

Skill(s) to be assessed on at trial (please tick one or more):-

Batter Seam Bowler Spin BowlerWicket Keeper 

Additional Supporting Comments: -

Photography & Video Consent (All Under 18s)

The IWCB/IWSCA recognise the need to ensure the welfare and safety of all young people in cricket. As part of our commitment to ensure the safety of young people we will not take photographs, video images or other images of young people without the consent of the Parents/Legal Guardians and the young person.

The IWCB/IWSCA will follow the guidance for the use of images of young people, as detailed within the ECB Welfare of Young People Policy.

The IWCB/IWSCA will take steps to ensure these images are used solely for the purposes they are intended, which is the promotion and celebration of the activities of the individuals, team and the IWCB/IWSCA.

If such photographs, e.g. team or action shots, are submitted to the Press individuals will not be identified. In exceptional circumstances, e.g. the selection of an individual player for Hampshire or England, where there is a need to identify the player in the Press, parental permission will be sought beforehand.

If you become aware that these images are being used inappropriately, you should immediately inform the County Welfare Officer

Medical Information

Does your child suffer from any condition/allergy, etc, requiring medical treatment?

If YES please give details.

To the best of your knowledge, has your child been in contact with any contagious or infectious diseases or suffered from anything in the last four weeks that may become contagious or infectious? If YES please give details.

Is your child allergic to any medication? If YES please specify.

Has your child received a tetanus injection in the last five years? YES/NO

Please give date, if known:

Please outline any special dietary requirements of your child.

I undertake to inform the Team Manager as soon as possible of any change in medical circumstances between the date signed and the cricket matches played.

I (Parent/Legal Guardian) consent/do not consent to the Isle of Wight Cricket Board/Isle of Wight Schools Cricket Association photographing or videoing

(Name of young person) under the stated rules and conditions and I confirm I have legal responsibility for this child and am entitled to give this consent. I also confirm that there are no restrictions related to taking photos, other than those given above

I confirm that the information above is accurate at the time of completion and any changes in the above information will be supplied to the Team Manager as quickly as possible.

Please return the completed form to: - with subject heading as Youth Nomination or post to IWCB (Nominations), Newclose Cricket Ground, Blackwater Rd, Newport, PO30 3BE.

□Please Tick if you are happy for us to share parent contact details with Newclose CCG and the Isle of Wight Cricket Centre to promote cricketing opportunities or fundraising events they may wish to promote.

Player Signature: Date:

Parent Signature: Date:

Please note any player that has outstanding fees from the 2013 season will not be allowed to trial until those fees are settled in full.