Effingham Cricket Club

Player Name: ______

D.O.B:______Age Group: U11 U12/3 U15

School:______

Player Name: ______

D.O.B:______Age Group: U11 U12/3 U15

School:______

Payment Method Cash / Cheque / BACS

Amount Paid:£______

Donations Welcome:£______

2017JUNIOR MEMBER

Parent/______

Guardian

Address:______

______

______

______

Home:______

Work:______

Mobile:______

Email:______

Effingham Cricket Club

2nd Parent/______

Guardian:

Address:______

______

______

______

Home:______

Work:______

Mobile:______

Email:______

2017JUNIOR MEMBER

Emergency______

Contact:

Address:______

______

______

______

Home:______

Work:______

Mobile:______

Relationship

to Player:______

Effingham Cricket Club

Doctors:______

Telephone:______

Please detail below any important medical information that the Club's coaches/junior coordinator should be aware of (e.g. epilepsy, asthma, diabetes etc.)

______

______

Medical consent:

□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 and/or the emergency contact named on this form.

□I confirm that to the best of my knowledge, my child does not suffer from any medical condition other than those detailed by me above.

2017JUNIOR MEMBER

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 your child to have a disability? / Yes / No
If yes, what is the nature of the disability?
______
______
______

Effingham Cricket Club

Automatic Non- Voting Membership Status

Junior membership of the Club provides that the parent(s)/carer(s)/guardian(s) of the child are given voting membership of the club as part of that junior membership. This entitles the parent(s)/carer(s)/guardian(s) additional privileges that would otherwise be gained by paying the appropriate adult membership fee(s). It also requires them to adhere to all the Policies, Codes of Conduct and Rules applicable to the Club. However any use of Club facilities by the junior member’s parent(s)/carer(s)/guardian(s) (for example social/training/playing) may incur charges.

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 (ECB). 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.

2017JUNIOR MEMBER

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.

Membership is £85 per player and this will include summer outdoor coaching and all JUNIOR matches. Any junior playing senior cricket is liable for a senior match fee.

Effingham Cricket Club

Guiding principles of the Club

Effingham Cricket Club operates under a number of guiding principles, Policies and Codes of Conducts. Copies of these documents can be made available on request and appear on the Club web site. A summary of the guidance of some of these documents can be found in the Safe Hands leaflet that is on the clubhouse notice board or on the ECB website.

The Club has adopted and adapted a number of ECB policies and codes of conduct:

Policies

EqualityInclusion & DiversityAlcohol

Child Protection & WelfareFirst AidTours

ChangingWebsitePhotography/videoTransport

Codes of Conduct

Coaches and Assistants

Players, Parents, Members and Guests

Umpires

2017JUNIOR MEMBER

By returning this completed Membership Form the parents/guardians and player:

  • agree to the player taking part in the activities of Effingham Cricket Club;
  • agree to photographs/video of the player being used inhard copy and online literature in accordance with the Club's Photography/video Policy;
  • agree to abide by the Club's Polices and Codes of Conduct

Player(s)

Sign: ______

Parent/Guardian/Carer

Sign: ______

Sign: ______

Date: ______

All completed forms must be given to Fran Bond

or emailed to

Cheques payable to: EFFINGHAM CRICKET CLUB / BACS: HSBC Epsom 40-20-24 61202537 pg. 1