SUMMER CAMPS 2015
APPLICATION FORM (please complete ONE FOR EACH CHILD)
Name of child …………………………..…………...... ….. Date of birth. ……...... ……..…....
Address ……………………… …………………...... ……………………………….………...... …...... …..…......
Postcode ...…….....…..………...... E-mail …….....…………………......
PLEASE LIST CLEARLY ALL DATES YOU WISH TO BOOK :
Venue: Dates:
Cost : £15 per day £3 per day discount if booking 3 or more days, paid in advance *
£3 per day discount for siblings (2nd, 3rd child, etc) *
* Must be postmarked 7 days or received 3 days before first day bookedI enclose payment of £ ………… Cheques payable to CORNWALL CRICKET BOARD LTD please
No refund will be given once we have received your payment – unless CCB Ltd has reason to cancel the event.
IMPORTANT Please give name of cheque payee in case of refund, as no cash can be given: ………………………………………………
All children should attend in sports clothing and bring appropriate refreshments / packed lunch. They may bring cricket equipment,
but this is not essential. Your child will be reserved a place on the course, unless otherwise notified.
Coaching will be undertaken by Cornwall Cricket Board Ltd’s ECB qualified Community Coaches and other approved qualified staff.PARENTS / CARERS: Please read carefully, and then sign the form.
Medical information: Please detail below any important medical information of which our coaches should be aware:
…………………………………......
EMERGENCY CONTACT: Please indicate the person(s) for contact in case of accident / injury:
Name …………………………..….…………...... …… Telephone ………...... …………….……………......
By signing this form, I agree to my child taking part in this course and I give permission for my child to be administered First Aid,
including any emergency treatment:
Signed (Parent / carer): …………………...... ……………...... ……..…..…….... Date: ……………...... …….…….....
Cornwall Cricket Board Data Protection Statement: Cornwall Cricket Board Ltd will hold the personal details provided by you on this form together with other information it may hold about you and use your data for the following purposes: training, providing goods and services, marketing, player profiles, statistical research such research into player and non-player participation and to inform you of any future cricket activities in Cornwall. We may share your information with third parties such as the ECB, ECB sponsors, Board commercial and non-commercial partners, schools, other Board Associations and equipment suppliers in accordance with our Privacy Statement (see Board website and available on request). We may need to contact you by mail (letters, posters and flyers), email and social media with information and offers of commercial products or services that we or the third parties believe may be of interest to you. Please ensure that you TICK the boxes below; otherwise it will be assumed that you consent to receive such material.
Information from Cornwall Cricket Board Ltd Information from ECB Information from third parties
YES NO YES NO YES NO
You have the right to see or to ask for a copy of any of your personal data held by the Board in connection with the above activities; for such enquiries or information, please contact the Board Cricket Development Manager, Joe Skinner, at the Cricket Centre on 01872 267138 or by email at . In addition, you have the right to ask for any inaccuracies in your data to be corrected or amendments made or to request that specific information be deleted.
Photography I confirm that I am happy for my child to be photographed / videoed for the purposes of advertising promotion of CCB Ltd activities. All
photos will be used according to the CCB Ltd Data Protection statement.
Yes No (Please tick the relevant box)
Send this completed form to: Michelle Kent, Cornwall Cricket Board Ltd, Gannel Building, College Road, Truro TR1 3XX
Further details: m.kent@cornwallcricket.co.uk 01872 267138 OR call Mark Mitchell 07805 787858