VALLEY DISTRICT CRICKET CLUB
Est. 1897/98
Affiliated with the Queensland Cricket Association
Headquarters: Ashgrove Sports Ground, Yoku Road, Ashgrove
Postal Address: Valley District Cricket Club, PO Box 240, Ashgrove Qld 4060
PLAYING MEMBER (SENIOR) REGISTRATION FORM
I, the undersigned, hereby make application for membership of the Valley District Cricket Club Inc as a Playing Member (Senior) and in connection therewith agree to pay to VDCC Inc. the applicable Annual Membership/Subscription Fee and Match Fees, in the event of my being accepted as a Playing Member (Senior) of Valley District Cricket Club Inc.
Name:
First NameAll Middle Name(s) (for Annual Report & Records)Surname
Address:Postcode:
Phone Nos:Home:Work:Mobile:
Email Address:Date of Birth://
Parent(s) / Legal Guardian(s) Name(s) and Contact Numbers if player under 18 years
Please tick the applicable box/boxes if, as at 31 August, 2010 you are: U18: >40: U15:
Please email your completed form to ASAP
Which club/team did you play for last season?:
Occupation of player (if student, write student): ____ Occupation(s) of parent(s) / legal guardian(s):
PLEASE READ THE FOLLOWING BEFORE SIGNING:
I, (player’s name or, if under 18 years, name of parent / legal guardian)
residing at (address)
hereby acknowledge that I have read, understood, acknowledge and agree to all the matters referred to in the numbered statements below including the warning, release and indemnity. If I am the player’s parent or legal guardian, I acknowledge that where “I” or “me” or “my” is written below it refers to the player and that when I sign below I am acting on behalf of the player and have read, understood, acknowledge and agree to all the matters referred to in the numbered statements below including the warning, release and indemnity.
(1)WARNING, INDEMNITY & RELEASE: I, in consideration of being allowed to participate in cricket matches, training, and all associated events (“Activities”) organised and/or supervised by Valley District Cricket Club Inc ABN 35550296330(‘VDCC’ /’The Club’) hereby acknowledge, agree and confirm the following:
(a)There are inherent risks associated with the Activities which may result in personal injury (even of a serious nature) to participants. I fully accept and agree to bear these risks.
(b)To the full extent permitted by law I absolve, release, discharge and indemnify Queensland Cricket Association Limited ACN 010 289 237 (‘Queensland Cricket’), VDCC, their officers, employees, representatives and agents (“Indemnities”) from any and all liability for any injury, loss, cost, charge, expense or damage suffered by me however caused, arising from or incurred directly or indirectly as a result of my participation in the Activities, including without limitation, where caused by any act, omission, default or negligence of the Indemnities.
(2)CONSENT TO DISCLOSURE - PRIVACY ACT (a): I acknowledge and agree that the personal details relating to me in this form, including without limitation my name and address, may be provided to Queensland Cricket / Cricket Australia and/or their affiliated bodies for use by that organisation as it sees fit in the course of its administration of cricket.
(3)CONSENT TO DISCLOSURE - PRIVACY ACT (b): I acknowledge and agree that the personal details relating to me in this form, including without limitation my name and address, may be provided to third parties as determined byVDCC from time to time.
(4)MEDIA & COMMUNICATIONS RELEASE: I authorize Queensland Cricket / Cricket Australiaand VDCC to take and use photographs, video or sound recordings of me and other reproductions or adaptations of my likeness (Material), either in full or part, in conjunction with any wordings or drawings. I understand the Material will be used for the purposes of advertising, promotion, media publicity, display,including, but not limited to the VDCC web site and/or for any other Queensland Cricket / Cricket Australia purpose in whole or in part.
(5)CLEARANCE:I am a financially clear member of my former club, and attach herewith a clearance from my former club if applicable.
(6)CODES OF BEHAVIOUR:I understand that I will be required to abide by the constitutions, regulations, policies, codesand spirit of the game as established by VDCC, Queensland Cricket, Cricket Australia, the International Cricket Council and the Laws of Cricket (‘the guidelines’). I acknowledge that VDCC, at its absolute discretion, may suspend my registration at any time where any perceived and/or actual breach of these guidelines occurs.
Signed: (Player’s signature, or that of parent/guardian if player under 18 years)
Dated this day of 20 Witness Signature: