COLTS MEMBERSHIP FORM 2018 SEASON

(School year 10 and younger)

We are very pleased to welcome you to Sarisbury Athletic Cricket Club.

This form is to be completed for all Colt members - new or existing. Please complete this form and return to Fran Slater by e-mail to r by hand via the Clubhouse. Please also ask your parents or guardian to sign the form before it is returned.

Please be aware that by filling in this form you consent to your contact details being used by the club committee, including (where appropriate) the Chair of Selectors, Team Captains, Secretary, Social Committee and Treasurer in order to keep you informed about club events, matches and other club information. Members may also be contacted occasionally by our club sponsors for the purposes of marketing.

We will also use this contact information in the event of any accident or emergency.

PART A - Members Personal details
Name:
Address:
Postcode:
Home Tel
Number:
D.O.B.
Current School
Year: / Year 4 or
Younger / Year 5 or
Year 6 / Year 7 or
Year 8 / Year 9 or
Year 10
Colts Mobile: (Optional) / By providing the contact details for your son/daughter/ child in your care you consent to this information being held byrelevant Captains/Managers on their personal devices.
Colts Email:
(Optional)
Parent/Carer
Names:
Parent/Carer
Mobile:
Parent/Carer
Email:
Please indicate below if there is a particular contact in case of emergency or accident, especially if this is different to parent/carer names above:

Contact name:

Emergency contact number:

Permission to take photographs? I CONSENT / DO NOT CONSENT to my child being photographed in team pictures or during matches and practice sessions (delete as appropriate). For further clarification, please read “SACC photographic policy” on the club website.
Note: both signatures are required

Parent /Carer signature

Child signature (aged 12-18) ______

Medical information:

Please detail below any important medical information that the club should be aware of (e.g. epilepsy, asthma, diabetes etc.) This information will not be shared unless a medical emergency arises.

By returning this completed form, I agree to my son/daughter/child in my care taking part in the activities of the club. I will ensure that clothing appropriate to the activities is worn. I understand that I will be kept informed of these activities – for example timing and transport details.

I accept that I remain responsible for my son/daughter/child in my care until the coaches/managers are present and that any use of hard balls and other cricket equipment before the coaches are in attendance is entirely at our own risk. I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately.

By signing this form I acknowledge that it is not only my son/daughter/child in my care but our family who will become members of Sarisbury Athletic Cricket Club and we will abide by the Code of Conduct and Rules laid down by the club I also acknowledge that the Code of Conduct has been made available to me on the SACC website.

Signature of Parent/Carer: Date:

The Colts Membership Fee for the 2018 Season is £120 – this includes a match shirt for all colts subsidised by the club.

If you would like to pay in instalments then please contact the membership secretary to make arrangements; all instalment payments must be received by 6thJuly 2018.

Please pay by electronic banking, details are:

Account Name: Sarisbury Athletic Cricket Club (SACC)

Sort Code: 20-30-89

Account Number: 20764043

Payment method selected: One off payment £

I would like to pay in instalments:

I would also like to make a donation to the club of (please insert amount):

If for any reason you are unable to pay electronically please contact the membership secretary.

Sarisbury Athletic Cricket Club is run by dedicated volunteers who give up their spare time so that others can enjoy playing cricket. The club provides thefacilities and equipment, along with qualified ECB Coaches. All other help andassistance, however, has to come from volunteers.

Please look at the list below and indicate any activity you may be able to help with. If there is any other way in which you could help please let us know.

Managing a Team / Coaching assistant / First Aid / Building Maintenance
Ground Maintenance / Scoring / Umpiring / Administration
BBQ’s
Feeding cricket stats to Webmaster / Bar work / Fundraising / Publicity
Ethnicity

In order to help the club monitor its membership please will you tick oneof the following boxes to identify your ethnic group/origin. Whilst it isnot compulsory that the following section is completed the footnoteat the end of this template explains why it is important.

A
B
C
D / WHITE
English/ Welsh/ Scottish/ Northern Irish/ British
Irish
Gypsy/ Irish Traveller
Other White background (please specify)
MIXED
White & Black Caribbean
White & Black African
White & Asian
Other Mixed/ Multiple Ethnic background (please specify)
ASIAN & ASIAN BRITISH
Indian
Pakistani
Bangladeshi
Chinese
Other Asian background (please specify)
BLACK & BLACK BRITISH
E
F / Caribbean
African
Other Black background (please specify)
ARAB OR ANY OTHER ETHNIC GROUP
Arab
Any other ethnic group (please specify)
I do not wish to disclose my ethnic origin to SACC
Disability

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
Hearing impairment
Physical disability
Learning disability
Multiple disability
Other (please specify)