Worlington Cricket Club Youth Registration and

Parental/Carer Consent Form for Away Fixtures17-18 winter and summer season.

This form is also to be used when taking young people on away fixtures. One copy should be taken by the team captain/manager. Worlington Cricket Club (WCC) will use one form per season for all away fixtures. The Home Contact will be provided with a fixture card and contact details of all Club Officials. The Home Contact will be advised of the club contact, prior to each away game.

Player: To ensure we have the correct contact details for each player, please insert the information requested below and return the form to Adam Gallop, or any youth coach or team captain. The form needs to be checked and signed by your parents or guardian.

Name / Date of Birth and school year.
Emergency Contact Name / Tel Home
Home Address / Tel Work
Tel Mobile
E-mail Address
Alternative Contact Name / Tel Home
Home Address / Tel Work
Tel Mobile
E-mail Address
Doctor’s name and contact number
  • I am aware of the ECB Welfare of Young People guidelines in relation to away fixtures. (A copy of the safe hands policy is available to view at the clubhouse or on the internet at )
  • I consent to my child taking part in the activities of the club. I acknowledge that the club will be liable in the event of any accident only if they have failed to take reasonable steps in their duty of care for my child during the session.
  • I agree to be at the pick-up/drop off point at the agreed time.
  • I agree to my son/daughter travelling to away fixtures.
  • I understand and accept all rules & regulations set out by Worlington Cricket Club and agree to pay the subscriptions which cover player insurance. - (All youth players need to be fully paid up members of W.C.C. to be covered by the clubs insurance when playing).
  • I have received a copy of the club’s code of conduct and will adhere to it.
  • I understand that if at any times I have any problems or complaints then I will let the club know in writing as soon as possible. Any complaints should go to the Child Welfare Officer.

Where possible U16 children will not change at the same time as adults. However, there may be occasions when this is not possible. I agree to my child sharing changing facilities with adults. Should I wish, I know I am able to supervise their changing (N.B.This relates to adult fixtures)

Yes/ No

During the season the club will take photographs of teams & players in action. Video recorders may also be used for coaching purposes. Photographs may be used to publicise activities at the club. Your consent is requested to allow us to continue with these practices.

Yes / No

Signed – Parent/Carer
Print Name
Date

Medical Information

1. Does your child experience any conditions requiring medical treatment and /or medication?

Yes / No

If yes please give details

2. Does your child have any allergies?

Yes / No

If yes please give details

3.Does your child have any specific dietary requirements?

Yes / No

If yes please give details

4.Does your child have any disabilities?

Yes / No

If yes please give details

5.Please provide any further information you feel is necessary.

  • I confirm to the best of my knowledge that my son/daughter does not suffer from any medical condition other than those detailed above.
  • I consent to my child receiving medical treatment which, in the opinion of a qualified medical practitioner, may be necessary.
  • I will ensure that If my child needs to carry medication it is brought to each match/training session and that the coach/manager is made aware

Signed – Parent/Carer
Print Name
Date

Child Welfare Officer

Adam GallopMobile: 07752 704579 Email:

In order for the E.C.B. to monitor membership please can you circle one of the following boxes to identify your ethnic group?

Ethnicity

A White

 British Irish Any other white background (please specify)

B Mixed

 White & Black Caribbean White & Black African White & Black Asian

 Any other mixed background (please specify)

C Asian or Asian British

 Indian  Pakistani Bangladeshi Any other Asian background (please specify)

D Black or Black British

 Caribbean African Any other Black Background (please specify)

E Chinese or other ethnic group

 Chinese Any other (please specify)

(Sport can and does play a major role in promoting inclusion of all groups in society. However, inequalities have traditionally existed within sport, particularly in relation to gender, race and disability. The England and Wales Cricket Board and Sport England are committed to promoting and developing sports equity, which is about fairness in sport, equality of access, recognising inequalities and taking steps to address them. By monitoring the profile of young people in sports clubs, national governing bodies of sport and Sport England can identify any issues relating to under-representation of different groups and can together develop strategies to ensure all young people have an opportunity in the future development and progress in sport.)

Official Use Only:
Annual Subs Paid
Yes / No
Received copy of code of conduct
Yes / No

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