Wellington Point Cricket Club Inc PO Box 2126, Wellington Point Qld 4160 Incorporation No. 1A12935 ABN

Transcription

1 Wellington Point Cricket Club Inc PO Box 2126, Wellington Point Qld 4160 Incorporation No. 1A12935 ABN Application for Membership Players Details 2015/16 PERSONAL DETAILS Player 1 Player 2 Player 3 Milo / In2Cricket Milo In2Cricket Milo In2Cricket Junior Senior Junior Senior Junior Senior Surname 1 st Name DOB Age on 01/09/2015 Year first start with WPCC Last Year s Team Shirt & Hat S H S H S H Size Address: Home Phone: Mobile: Work: Facsimile: PARENTS /GUARDIANS (U18) DETAILS: Mother s Name: Daytime Contact No: Father s Name: Daytime Contact No:

2 In Case of Emergency Please Contact: Blood Group (if known) Do you take any regular medications? If Yes Please Specify Have you had Vision: Epilepsy Do you wear? Hepatitis A Glasses Hepatitis B Contact lenses Diabetes Heart Problems Hernia Vaccinations Hepatitis A Other: If other, please specify. Hepatitis B Tetanus, if yes when Other: Asthma Do you suffer from asthma? Do you take medication for asthma? If yes, specify Do you bring your medication to training/competition? List any other allergies you have: Injury Details: Do you have a pre-existing injury/condition that may affect your participation/performance? If yes, please list: Have you received medical clearance from your doctor for this season?

3 RISK MANAGEMENT: Do you have a Volunteer Blue Card If Yes, Please Provide Details Number Expiry If No, Have you ever been declined for a Volunteer Blue Card Do you hold a Current First Aid Certificate or Qualification If Yes, Please Provide Details Would you like to be a Club First Aid Officer and Receive the Volunteer Rebate Can you help us in any other way and Receive the Volunteer Rebate: Coaching Managing Committee Do you allow the use of personal cricket photos on our club website & promotional advertising: Yes No Signature:... Date:... OFFICE USE: Sign On Date / / 2015 Rego Due $ Amount Paid $ Amount Owing $ WPCC Receipt Number MSRC Receipt Number Grant Receipt Number Paid By EFT Cash Direct Credit Cheque Get in the Game Grant

4 Wellington Point Cricket Club Inc PO Box 2126, Wellington Point Qld 4160 Incorporation No. 1A12935 ABN INDEMNITY I/We... am/are the parents or legal guardians of my/our child... I/We agree to my/our child being allowed to participate in cricket matches, training, including travel and associated events ( Activities ) organised and/or supervised by Wellington Point Cricket Club. In consideration of Wellington Point Cricket Club allowing my/our child to take part in the Activities, I/we acknowledge, agree and confirm the following: (a) (b) That there are inherent risks associated with the Activities which may result in my/our child being injured in a serious manner. I/we fully accept and agree to bear those risks in own right and on behalf of my/our child. To the full extent permitted by law, I/we agree both on behalf of my/our child and in my/own respective rights to absolve, indemnify, release and discharge Wellington Point Cricket Club, its Officers, Employees, Representatives and Agents ( Indemnitees ) from any and all liability for any injury, loss, cost, charge, expense or damage suffered by me/us or my/our child however caused, arising from or incurred directly or indirectly as a result of my/our child s participation in the Activities, including without limitation as a result of any act, default, omission or negligence of the Indemnitees. PRIVACY LEGISLATION CLAUSE Information requested in this Nomination Form is requested under the National Privacy Provisions detailed in the Privacy Act Accordingly we advise that: The details contained in Personal Details and Parents /Guardians Details may be entered onto the Queensland Cricket general data base to enable Queensland Cricket to fairly and reasonably maintain appropriate records of all persons who are or have been involved or connected with any aspect of our business. The details requested in Health Care and Medical Details will be held on a discreet Wellington Point Cricket Club Data Base so that appropriately qualified Club Volunteers may effectively act on any eventuality that may arise whilst the person on whom the details are kept, is under the care, control and jurisdiction of Wellington Point Cricket Club. Details kept on this

5 discreet database will be destroyed and/or permanently de-identified once the need to maintain such records is extinguished. Wellington Point Cricket Club maintains an express policy on all data collected and maintained which relates to individuals. Details of this policy are available on request. 1. I/We have read, understood, acknowledge and agree to all the matters referred to in the statement, including the warning, release and indemnity. 2. I/We have read and understood the above PRIVACY LEGISLATION CLAUSE and give WELLINGTON POINT CRICKET CLUB and QUEENSLAND CRICKET authorization to record and use the information supplied, for the purposes detailed. 3. I/We hereby give consent for any photographs/electronic media (eg video) of /our/my child to be published by Wellington Point Cricket Club, Queensland Cricket and/or Cricket Australia for the purpose of marketing, newsletters, publications or other cricket-related business. To the best of my knowledge, all information contained on this format is correct (if younger 18 please have parent or legal guardian sign). Signature:... Date:... Signature:... Date:...

6 Obligations towards the Game A player must: PLAYERS CODE OF CONDUCT Our Pride 1. Set a positive example for others, particularly young players and supporters. 2. Make every effort consistent with Fair Play and the Laws of the Game to help his/her own team win. 3. Adopt professional appearance relating to language, manner, temper, dress and punctuality is to be adopted at all times. 1. Know and abide by the Laws, rules and spirit of the game, and the competition rules. 2. Accept success and failure, victory and defeat, equally. 3. Be responsible for their own equipment in order to prevent any danger to self or others. Respect towards Opponents & Match Officials A player must: 1. Treat opponents with due respect at all times, irrespective of the result of the game. 2. Verbal abuse of officials and unnecessary/incessant sledging of other players, along with the deliberately distracting or provoking of an opponent, are not acceptable or permitted behaviors 3. Avoid all forms of gamesmanship, and time-wasting. 4. Accept the decision of the Match Official without protest. 5. Avoid words or actions which may mislead a Match Official. 6. Show due respect towards Match Officials. 7. Avoid using any foul, abusive or offensive language towards Match Officials or opponents. 8. Abide by the instructions of their Coach and Team Officials, provided they do not contradict the spirit of this Code. 9. Show due respect towards the Team Officials of the opposition. Obligations towards the Club A player must: 1. Pay all fees by their due date 2. Inform the team coach/manager of their availability at least 72 hours prior to each match and participate in all club activities where possible. 3. Not act in any way that could harm the clubs standing in the community at any given time, as determined unanimously by the Full Executive Committee 4. Respect the clubs faculties and equipment I understand that if I do not follow the Code, any/all of the following actions may be taken by the club,: Be required to apologise to team-mates, the other team, umpire or team coach/manager Receive a warning from the coach or club board Be dropped or substituted for a minimum of one (1) weekend s play. Be required to serve a suspension of at least one (1) match Be expelled from the club. Signed (Name of Player/Guardian) / / (date)

7 Wellington Point Cricket Club Inc 2015/16 FULL SEASON SIGN ON FEES ***$25 discount if Full Season Sign-on Fees are paid by 15/08/2015*** NO PAY, NO PLAY Number of Players WPCC Fee Mooroondu Fees Total Payment due Sign-on day Returning & Referral Member Rebate Volunteer Rebate * Game Day Fees Milo In2 Cricket $75.00 N/A $75.00 N/A N/A N/A Single (Junior) $ $45.00 $ $15.00 $75 $5 pw Single (Senior) $ $45.00 $ $15.00 $75 $15 pw 2 Players (Junior) 2 Players (inc 1 Senior) 3 Players (Junior) 3 Players (inc 1 Senior) 4 Players (Junior) 4 Players (inc 1 Senior) $ $50.00 $ $30.00 $75 N/A $ $50.00 $ $30.00 $75 N/A $ $50.00 $ $60.00 $75 N/A $ $50.00 $ $60.00 $75 N/A $ $50.00 $ $75.00 $75 N/A $ $50.00 $ $75.00 $75 N/A 2015/16 HALF SEASON SIGN ON FEES Number of Players WPCC Fee Mooroondu Fees Total Payment Due Sign-on day Returning & Referral Member Rebate Volunteer Rebate * Game Day Fees Single (Junior) $ $45.00 $ $15.00 $35 $5 pw Single (Senior) $ $45.00 $ $15.00 $35 $15 pw You can also EFT prior to sign on day - BSB , Account # (Include your surname in the payment details, if available).

8 * Volunteer Rebates will be paid on the following basis: Nomination and Acceptance as Executive or Committee Member for Season 2015/16 Nomination as Coach and Completion of Level 0 and/or Level 1 CA Coaching Course Nomination as Junior Team Manager, Team Scorer or Junior Club Umpire Fund Raising Committee Member including but not limited to:- Completing the weekly raffle roster at Redland Sporting Club Assist with sign on day and associated activities. Formation day assisting committee with sausage sizzle and associated activities Trophy and presentation day organisation. Working bees throughout the season Separate Volunteer Rebates will be paid at discretion of the Executive for those Members who also assist on a consistent basis at the Nomination of Team Manager & Coach at the end of season Committee & Coaching staff will also receive a club shirt in addition to their rebate.