Bexleyheath Cricket Club

Colts Membership Form

We are very pleased to welcome you to Bexleyheath Cricket Club. To ensure that we have the correct contact details for you, please fill out this form and hand it to the registration secretary on the enrolment evening.

If you are under the age of 18, please ask your parent / carer / legal guardian to sign the form before it is returned so as they understand the terms and conditions of the membership. We will also use this information to keep you informed about events and information from Bexleyheath Cricket Club. We will not disclose this information to any unauthorised third party.

Section 1 – Personal Details (young person under the age of 18).

Name
Age, Date of Birth & School Year
Name of School / College

Section 2 - Personal Details (Parents / Carers / Legal Guardians).

Name
Address
Postcode
Parents Occupation (We are looking for potential volunteers to help within the club)
Home Tel No
Mobile No

E-mail

Section 3 – Disability - Please enter player’s details

The Disability Discrimination Act 1995 defines a disabled person as anyone with a ‘physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities’.

Do you consider yourself to have a disability? Yes No

If yes, what is the nature of your disability?

Visual impairment Physical disability Multiple disability

Hearing impairment Learning disability

Other (please specify):

Section 4 – Ethnic Background - - Please enter player’s details

Please tick the box below that describes your ethnic background. This information is vital to us to know that we are an inclusive club.

White British White Irish White European White Other

Afro Caribbean Asian Oriental

Country of Birth______Date last entered the U.K.______

Section 5 – Sporting information

Have you played cricket before? Yes No

If yes, where have you played cricket? (Please indicate below)

Primary School Special Education Needs School

Secondary School Local Authority Coaching Session(s)

Club BDC Coaching Course(s)

District County

Other (Please specify)

Section 6 – Medical Information

Name of Doctor / Surgery
Doctor / Surgery Tel No

Please detail below any important medical information that our Coaches / Child Welfare Officers / Junior Co-ordinators should be aware of (e.g. Asthma, epilepsy, diabetes etc).

Section 7 – Emergency Contact Details. (Alternative contact)

In the event of an incident or emergency situation, where a parent / guardian / carer named above, cannot be contacted, please provide details of an alternative adult who can be contacted by the club. Please make sure that this person is aware that you have given us his or her contact details.

Name of alternative contact
Relationship of this person to the young person (e.g. Aunt, Neighbour etc.)
Home Tel No
Mobile No

Section 8 – Permission for the use of photographs or recorded images.

Bexleyheath Cricket Club recognises the need to ensure the welfare and safety of all Young People in Cricket. As part of this commitment we will not permit photographs, video images or other images of Young People to be taken or used without the consent of the parent / carer / legal guardian and the Young Player. Bexleyheath Cricket Club follows the guidance issued in ‘Safe Hands – Welfare of Young People in Cricket’ on the use of images of Young People, which is available at Bexleyheath Cricket Club will take steps to ensure that these images are used solely for the purpose they are intended, which is the promotion and celebration of cricketing activities.

Bexleyheath Cricket Club understands that there are circumstances under which a parent / carer / legal guardian would not wish their child to be photographed. Whilst Bexleyheath Cricket Club will do all that it can to ensure the safety of children during photographed events, it is the responsibility of the parent / carer / legal guardian concerned to ensure that if their child is not to be photographed and partakes in an activity and is by the nature of the activity inadvertently photographed or filmed, Bexleyheath Cricket Club cannot be held responsible.

Section 9 – Transportation to matches and coaching sessions.

Bexleyheath Cricket Club’s policy is that the parent / carer / legal guardian are responsible for transporting their children to and from all matches and practice sessions and therefore the club will not be registering Private Vehicles for the transportation of individuals in connection with any fixtures or practice sessions arranged by the Club. The implementation of this policy is not intended to exclude any player from participation and parents / carer / legal guardian should contact the Club Welfare Officer if they have any problems with the transportation of players to matches or practice sessions.

Section 10 – Club changing policy

For players under the age of 18 playing in adult teams the following policy applies:

Young players uncomfortable with changing or showering with adults are under no obligation to do so and are advised to change and shower at home.
Parental consent must be given if Young Players are to share changing facilities with adults.
If Young Players are sharing changing facilities with adults, parents have the option to supervise them whilst they are changing. The club will make reasonable efforts to arrange this.

Section 11 – Data Protection

The Club will use the information provided on this Membership Form (together with other information it obtains about the player) to administer his / her cricketing activity at the Club and in any activities in which he / she participates through the club and to care for and supervise activities in which he / she is involved.

In some cases this may require the club to disclose the information to County Boards, Leagues and to the England and Wales Cricket Board. In the event of a medical issue or child protection issue arising, the club may disclose certain information to doctors or other medical specialists and / or to police, children’s social care, the courts and / or probation officers and, potentially to legal and other advisers involved in an investigation.

As the person completing this form, you must ensure that each person whose information you include in this form knows what will happen to their information and how it may be disclosed.

Section 12 – Consent

By returning this completed membership form: -

I agree to the child in my care taking part in the activities of Bexleyheath Cricket Club

I understand that I will be kept informed of activities of Bexleyheath Cricket Club. For example times of matches, coaching sessions and transport details as detailed in the introductory letter.

I give my consent that in an emergency situation, the club may act in loco parentis, if the need arises, for the administration of emergency first aid and / or other medical treatment, which in the opinion of a qualified medical practitioner may be necessary. I also understand that in such an occurrence, that all reasonable steps will be taken to contact me, or the alternative adult whom I have named in section 7 of this form.

I understand and accept the club’s policy on transportation, photography, videoing and changing policies, as detailed above.

I confirm that to the best of my knowledge, my child does not suffer from any medical condition, other than those detailed in section 6 of this form.

I consent to my child’s name being published with any related photograph in authorised club / event publications or press articles.

I agree that the young person in my care will be bound by the junior code of conduct of Bexleyheath Cricket Club.

I further agree that I will be bound by both the junior and adult code of conduct of Bexleyheath Cricket Club

I understand that I need to reply to team notification communications within 36 hours of it being received. Please ensure that you check your ‘spam’ folder for e-mails from the club.

Do you currently receive the ‘Dibbly Dobbly’ Newsletter? Yes / No

Signed
(Parent / Carer / Legal Guardian)
Print Name
(Parent / Carer / Legal Guardian)
Date

For Club use only

Cricket Club Membership fee received
BHSC Social Membership fee received